Active NPI
Santosh Bandugula Reddy, MD
- Pediatrics Physician
- Fort Defiance, AZ
National Provider Identifier
1114000833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C1-0001770
- Practice address
- Corner of Route N12 and N7
Fort Defiance, AZ 86504 - Phone
- (928) 729-8713
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C1-0001770 | DE | Primary |
Addresses
Primary practice location
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Mailing address
P.O Box 589
Fort Defiance Indian Hospital Board
Fort Defiance, AZ 86504
Phone (928) 729-8713
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000166002 | Medicaid | DE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1-0001770 | DE | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1114000833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O BOX 589",
"address_2": "FORT DEFIANCE INDIAN HOSPITAL BOARD",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "86504",
"telephone_number": "928-729-8713",
"fax_number": "928-729-8734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CORNER OF ROUTE N12 AND N7",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "86504",
"telephone_number": "928-729-8713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDY",
"first_name": "SANTOSH",
"middle_name": "BANDUGULA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "DE",
"license": "C1-0001770",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000166002",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Defiance, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.