Active NPI
Mousami Surapaneni
- General Practice Dentistry
- Temple, TX
National Provider Identifier
1053963967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35449
- Practice address
- 3108 S 31St St Ste 2108
Temple, TX 76502-1803 - Phone
- (408) 813-3941
- NPI assigned
- Jul 11, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35449 | TX | Primary |
Addresses
Primary practice location
3108 S 31St St Ste 2108
Temple, TX 76502-1803
Mailing address
3165 Hidalgo Loop
Round Rock, TX 78665-2156
Phone (408) 813-3941
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250815000851 | TX | Order and Referring Only - Dentist | 1254830441 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35449 | TX | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1053963967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3165 HIDALGO LOOP",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786652156",
"telephone_number": "408-813-3941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3108 S 31ST ST STE 2108",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765021803",
"telephone_number": "408-813-3941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURAPANENI",
"first_name": "MOUSAMI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-11",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "35449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temple, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.