NPIMap

Individual provider Active NPI

Jyostna Deepika Pulla, MD

  • Internal Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1114274586
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301100546 Issued in MI
Practice address
11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone
(260) 266-2020
Fax
(260) 266-2009
NPI assigned
Aug 5, 2012
Last updated
Apr 25, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301100546 MI Primary
Pediatrics Physician 208000000X 4301100546 MI

Addresses

Primary practice location

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701

Mailing address

1313 Winding Ridge Dr Apt 2B
Grand Blanc, MI 48439-7553
Phone (484) 343-8071

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20200217001408 NC Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Pediatric Medicine 6901195205 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine, Pediatric Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301100546MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Internal Medicine CurrentSince Mar 6, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 6, 2022 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Internal Medicine CurrentSince Jan 6, 2020 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Internal Medicine Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 6, 2020 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204
Phone (704) 355-2884

Interoperability endpoints

  • Direct secure messaging: jpulla499703@carolinashealthcaresystem.direct-ci.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1344124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1114274586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 WINDING RIDGE DR APT 2B",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397553",
            "telephone_number": "484-343-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-266-2020",
            "fax_number": "260-266-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLA",
        "first_name": "JYOSTNA",
        "middle_name": "DEEPIKA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-05",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301100546",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301100546",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.