NPIMap

Individual provider Active NPI

Prasad Venkata Kannaeganti, MD

  • Nephrology Physician
  • North Richland Hills, TX
National Provider Identifier
1114922630
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
N1701 Issued in TX
Practice address
6331 Boulevard 26
Suite 220
North Richland Hills, TX 76180-1590
Phone
(817) 628-0284
Fax
(817) 628-0288
NPI assigned
Jun 21, 2005
Last updated
Dec 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X N1701 TX Primary

Addresses

Primary practice location

6331 Boulevard 26
Suite 220
North Richland Hills, TX 76180-1590

Mailing address

1600 Waters Ridge Dr Ste a
Lewisville, TX 75057-6039
Phone (972) 219-0558

Other identifiers 1

IdentifierTypeStateIssuer
289661501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20120123000474 TX Practitioner - NephrologyPractitioner - Internal Medicine 7214904374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6331 Boulevard
26 Suite 220
North Richland Hills, TX 76180-1592
Phone (817) 628-0284

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.66 of 100Reported as group
Quality
78.39
Promoting interoperability
100
Improvement activities
40
Cost
77.16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N1701TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Texas Kidney Disease Associates Nephrology CurrentSince Sep 1, 2011 Accepting new patients
North Texas Kidney Disease Associates Nephrology CurrentSince Sep 1, 2011 Accepting new patients
North Texas Kidney Disease Associates Nephrology Current Accepting new patients

Locations

3315 Colorado Blvd
Ste 102
Denton, TX 76210
Phone (940) 320-1708

1600 Waters Ridge Dr
Ste A
Lewisville, TX 75057
Phone (940) 320-1708

6331 Boulevard 26
Ste 220
North Richland Hills, TX 76180
Phone (817) 628-0284

Interoperability endpoints

  • Direct secure messaging: prasad.kannaeganti.1@23918.direct.athenahealth.com
  • Direct secure messaging: prasad.kannaeganti@northtexaskidney.directbygreenway.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1114922630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WATERS RIDGE DR STE A",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576039",
            "telephone_number": "972-219-0558",
            "fax_number": "214-466-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6331 BOULEVARD 26",
            "address_2": "SUITE 220",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761801590",
            "telephone_number": "817-628-0284",
            "fax_number": "817-628-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNAEGANTI",
        "first_name": "PRASAD",
        "middle_name": "VENKATA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "N1701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289661501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Richland Hills, TX

Sources for this page

Verify at the official NPI Registry.