NPIMap

Individual provider Active NPI

Prasanth Nuthakki, MD

  • Interventional Pain Medicine Physician
  • Munster, IN
National Provider Identifier
1114046455
Registry record updated Aug 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
01071908A Issued in IN
Practice address
701 Superior Ave Ste B
Munster, IN 46321-4038
Phone
(219) 333-4757
Fax
(219) 401-4757
NPI assigned
Mar 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X 01071908A IN
Physical Medicine & Rehabilitation Physician 208100000X 01071908A IN
Interventional Pain Medicine Physician 208VP0014X 01071908A IN Primary

Addresses

Primary practice location

701 Superior Ave Ste B
Munster, IN 46321-4038

Mailing address

PO Box 3039
Munster, IN 46321-0039
Phone (937) 985-4010

Other practice location 1

24 Joliet St
Dyer, IN 46311-1705
Phone (219) 864-2237

Other identifiers 1

IdentifierTypeStateIssuer
201134860MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130219000392 IN Practitioner - Physical Medicine and RehabilitationPractitioner - Interventional Pain Management 2567596117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Interventional Pain Management
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Interventional Spine and Joint Specialists, LLCGroup PAC ID 9335562255, 2 clinicians

Practice addresses (Care Compare)

701 Superior Ave
Suite B
Munster, IN 46321-4038
Phone (219) 333-4757

Hospital & facility affiliations

  • Franciscan Health Dyer Hospital, Dyer, IN, CCN 150090
  • Franciscan Health Munster Hospital, Munster, IN, CCN 150165
  • Community Hospital Hospital, Munster, IN, CCN 150125
  • Franciscan Health Crown Point Hospital, Crown Point, IN, CCN 150126
  • Franciscan Health Michigan City Hospital, Michigan City, IN, CCN 150015

Merit-based Incentive Payment System (MIPS)

Final score
86.27 of 100Reported as individual
Quality
91.56
Promoting interoperability
100
Improvement activities
40
Cost
62.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional Spine and Joint Specialists, LLC Physical Medicine & Rehabilitation CurrentSince Feb 10, 2020 Accepting new patients
Major Hospital Interventional Pain Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Interventional Pain Medicine Past Accepting new patients

Locations

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

759 45th St
Ste 201
Munster, IN 46321
Phone (219) 836-0296

701 Superior Ave
Ste B
Munster, IN 46321
Phone (219) 333-4757

Interoperability endpoints

  • Direct secure messaging: pnuthakki222328@direct.franciscanalliance.org

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627776000000",
    "number": "1114046455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3039",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463210039",
            "telephone_number": "937-985-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SUPERIOR AVE STE B",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214038",
            "telephone_number": "219-333-4757",
            "fax_number": "219-401-4757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Joliet St",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463111705",
            "country_code": "US",
            "telephone_number": "219-864-2237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUTHAKKI",
        "first_name": "PRASANTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2021-08-01",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "IN",
            "license": "01071908A",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "01071908A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "01071908A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201134860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.