Supraja R. Gulla, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

T4929 Issued in TX

Practice address

4945 Williams Dr
Georgetown, TX 78633-2008

Phone

(317) 962-2894

NPI assigned

Sep 24, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sgulla1201906@direct.sw.org

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.

• Indiana Clinic Critical Care LLC

  • Pulmonary Disease Physician
  • Indianapolis, IN
  • NPI 1417285230

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1222214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1104076389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4945 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786332008",
            "telephone_number": "317-962-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLA",
        "first_name": "SUPRAJA",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-24",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.054210",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01069786A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01069786A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "T4929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201037090",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgulla1201906@direct.sw.org",
            "affiliation": "N",
            "address_1": "4945 Williams Dr",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786332008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Griselda Pattillo, LCSW PLLC
• Emily Wilburn Grooms, M.A., CCC-SLP
• Guadalupe County Hospital Board
• Guadalupe County Hospital Board
• Carly Gubin
• Jeffrey Gunter, FDN-P, CFMHC
• Nadia Gutierrez
• Victoria Evette Guyton, N.P.
• H-E-B, LP
• H-E-B, LP

• Internal Medicine Physician in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.