Individual provider Active NPI

Vittal Kumar Chundru, M.D.

  • Internal Medicine Physician
  • Tyler, TX
National Provider Identifier
1073784484
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
P3304 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 606-4129
Fax
(903) 606-1201
NPI assigned
Mar 13, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME101125 FL
Hospitalist Physician 208M00000X 30627 OK
Hospitalist Physician 208M00000X P3304 TX
Internal Medicine Physician 207R00000X P3304 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3347
Phone (918) 488-6001

Other practice location 1

6161 S Yale Ave
Tulsa, OK 74136-1902
Phone (918) 502-1900

Other identifiers 2

IdentifierTypeStateIssuer
281301700MedicaidFL
310170108MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221107001376 IA Practitioner - Internal Medicine 4486720414 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P3304TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation Internal Medicine CurrentSince Jan 27, 2024 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Sioux City Hospitalist Group, LLC Hospitalist CurrentSince Oct 15, 2022 Accepting new patients
St Francis Medical Center, Inc Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1026 A Ave NE
Cedar Rapids, IA 52402
Phone (319) 369-5970

801 5th St
Sioux City, IA 51101
Phone (712) 279-2010

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

1801 Inwood Rd
Fl Seventh
Dallas, TX 75235

Interoperability endpoints

  • Direct secure messaging: vchundru1024901@direct.unitypoint.org
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 5

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": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1073784484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "SUITE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363347",
            "telephone_number": "918-488-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-606-4129",
            "fax_number": "903-606-1201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6161 S Yale Ave",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741361902",
            "country_code": "US",
            "telephone_number": "918-502-1900",
            "fax_number": "918-494-6303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNDRU",
        "first_name": "VITTAL",
        "middle_name": "KUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-13",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME101125",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OK",
            "license": "30627",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "P3304",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "P3304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281301700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "310170108",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.