Individual provider Active NPI

Avinash Boddapati, MD

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1083900039
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
T8492 Issued in TX
Practice address
18707 Hardy Oak Blvd Ste 410
San Antonio, TX 78258-4791
Phone
(877) 504-8504
NPI assigned
Jun 28, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 282697 NY
Child & Adolescent Psychiatry Physician 2084P0804X 282697 NY
Psychiatry Physician 2084P0800X T8492 TX Primary

Addresses

Primary practice location

18707 Hardy Oak Blvd Ste 410
San Antonio, TX 78258-4791

Mailing address

450 Seaview Ave
Staten Island, NY 10305-3401
Phone (718) 226-9000

Other practice location 1

450 Seaview Ave
Staten Island, NY 10305-3401
Phone (718) 226-8910

Other identifiers 1

IdentifierTypeStateIssuer
0-4365486MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160913000161 NY Practitioner - Psychiatry 6406146745 Reassigns benefits to 1 organization
I20240221003907 TX Practitioner - Psychiatry 6406146745 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5788 Eckhert Rd
San Antonio, TX 78240-3900
Phone (210) 450-7222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
282697NYMDPsychiatry Physician
T8492TXMDPsychiatry Physician
N/ANCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at San Antonio CurrentSince Feb 1, 2024 Accepting new patients
North Shore-Lij Medical PC CurrentSince Sep 30, 2019 Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince Feb 1, 2024 Accepting new patients
University of Texas Health Science Center at San Antonio Current Accepting new patients
Bexar County Board of Trustees for Mental Health Mental Retardation CurrentSince Feb 12, 2024 Accepting new patients
Upstate Physician Services, PC PastSince Jun 1, 2016 Accepting new patients

Locations

300 Community Dr
Plandome, NY 11030

450 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-6279

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

972 Brush Hollow Rd
Westbury, NY 11590

5210 Thousand Oaks Dr
Ste 1238
San Antonio, TX 78233

6800 Park Ten Blvd
Ste 200S
San Antonio, TX 78213
Phone 21026110001060

5788 Eckhert Rd
San Antonio, TX 78240
Phone (210) 450-6450

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

Interoperability endpoints

  • Direct secure messaging: aboddapati48099@direct.utmsa.com

Organizations & group practices 6

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": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1083900039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053401",
            "telephone_number": "718-226-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18707 HARDY OAK BLVD STE 410",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584791",
            "telephone_number": "877-504-8504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Seaview Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103053401",
            "country_code": "US",
            "telephone_number": "718-226-8910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODDAPATI",
        "first_name": "AVINASH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-28",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "282697",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "282697",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "T8492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0-4365486",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.