Individual provider Active NPI

Jaya Adabala, M.D.

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1063673119
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD0000045194 Issued in TN
Practice address
6019 Walnut Grove Rd
Memphis, TN 38120
Phone
(901) 226-3610
Fax
(901) 226-3612
NPI assigned
Jun 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD0000045194 TN Primary

Addresses

Primary practice location

6019 Walnut Grove Rd
Memphis, TN 38120

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446

Other practice location 1

1030 Jefferson Ave
Memphis, TN 38104-2127
Phone (901) 523-8990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45194TNMDPharmacist
MD0000045194TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broca Inpatient Services Internal Medicine Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1063673119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 WALNUT GROVE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38120",
            "telephone_number": "901-226-3610",
            "fax_number": "901-226-3612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381042127",
            "country_code": "US",
            "telephone_number": "901-523-8990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADABALA",
        "first_name": "JAYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD0000045194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.