Individual provider Active NPI

Cherukupalli Srinivas Rao, DDS

  • Dentist
  • Chico, CA
National Provider Identifier
1073581856
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
49492 Issued in CA
Practice address
1074 East Ave Ste R
Chico, CA 95926-1052
Phone
(530) 345-4780
Fax
(530) 345-4781
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 49492 CA Primary

Addresses

Primary practice location

1074 East Ave Ste R
Chico, CA 95926-1052

Mailing address

1074 East Ave Ste R
Chico, CA 95926-1052
Phone (530) 345-4780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160915002661 CA Order and Referring Only - DentistPractitioner - Dentist 6204122377

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
49492CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
C.Srinivas Rao,D.D.S., Inc. CurrentSince Apr 25, 2021 Accepting new patients

Locations

1074 East Ave
Ste R
Chico, CA 95926
Phone (530) 345-4780

Interoperability endpoints

  • Direct secure messaging: crao@direct.westerndental.com

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": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537142400000",
    "number": "1073581856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1074 EAST AVE STE R",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261052",
            "telephone_number": "530-345-4780",
            "fax_number": "530-345-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1074 EAST AVE STE R",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261052",
            "telephone_number": "530-345-4780",
            "fax_number": "530-345-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAO",
        "first_name": "CHERUKUPALLI",
        "middle_name": "SRINIVAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2018-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "49492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chico, CA

Sources for this page

Verify at the official NPI Registry.