Kiranmai Bandaru, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD.203991 Issued in LA

Practice address

555 Lakes Blvd
Breaux Bridge, LA 70517-3240

Phone

(337) 332-3971

Fax

(337) 332-3973

NPI assigned

Sep 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12117/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/HBAHCD

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Sunshine Pediatric and Family Clinic LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
  • NPI 1619618964

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

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.

• Sunshine Pediatric and Family Clinic LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
  • NPI 1619618964

  Pediatrics

  Medicare reassignment NPD
• Acadiana After Hours, LLC

  • Family Nurse Practitioner
  • Crowley, LA
  • NPI 1780054221
  NPD (past)
• Pediatric Group of Acadiana, LLC

  • Specialist
  • Lafayette, LA
  • NPI 1265499628
  NPD (past)

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473465600000",
    "number": "1104159243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 YOUNGSVILLE HWY",
            "address_2": "SUITE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085173",
            "telephone_number": "337-330-0031",
            "fax_number": "337-330-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 LAKES BLVD",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705173240",
            "telephone_number": "337-332-3971",
            "fax_number": "337-332-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDARU",
        "first_name": "KIRANMAI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-08",
        "last_updated": "2016-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "003436",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD.203991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2125532",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Assured Adult Day Health Care Center, Inc.
• Clarissa Auzenne
• Avaeli Chiropractic, LLC
• Jemia Baise
• Candice Elizabeth Baker
• Nia Kenya Banks
• Baymark Health Services of Louisiana, Inc.
• Cirstie Beaubouef, LPC
• Sharon Kim Beazley, M.S.CCC-SLP
• Lottie Beebe

• Pediatrics Physician in Breaux Bridge, LA
• Providers in Breaux Bridge, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.