NPIMap

Individual provider Active NPI

Suresh B Indupalli, M.D.

  • Family Medicine Physician
  • Beaumont, TX
National Provider Identifier
1053372359
Registry record updated Jul 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L0828 Issued in TX
Practice address
4180 Delaware St
Suite 102
Beaumont, TX 77706
Phone
(409) 835-4907
Fax
(409) 347-0070
NPI assigned
Mar 28, 2006
Last updated
Jul 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L0828 TX Primary

Addresses

Primary practice location

4180 Delaware St
Suite 102
Beaumont, TX 77706

Mailing address

4180 Delaware St
Suite 102
Beaumont, TX 77706-7858
Phone (409) 835-4907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040207000142 TX Practitioner - Family Practice 4789577198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4180 Delaware St
Suite 102
Beaumont, TX 77706-7859
Phone (409) 892-6331

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
45 of 100Reported as individual
Quality
90
Improvement activities
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Suresh B Indupalli MD PA Family Medicine CurrentSince Apr 1, 2003 Accepting new patients
Southeast Emergency Physician Associates, P.a. Past Accepting new patients
C H Wilkinson Physician Network Family Medicine Past Accepting new patients

Locations

4180 Delaware St
Ste 102
Beaumont, TX 77706
Phone (409) 835-4907

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532217600000",
    "number": "1053372359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4180 DELAWARE ST",
            "address_2": "SUITE 102",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067858",
            "telephone_number": "409-835-4907",
            "fax_number": "409-347-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4180 DELAWARE ST",
            "address_2": "SUITE 102",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "77706",
            "telephone_number": "409-835-4907",
            "fax_number": "409-347-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDUPALLI",
        "first_name": "SURESH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2018-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L0828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.