Ravi Konidala, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M6981 Issued in TX

Practice address

1050 E Loop 304
Suite 200, Etmc Rural Health Clinic
Crockett, TX 75835-1814

Phone

(936) 544-5132

Fax

(936) 544-8029

NPI assigned

Sep 12, 2005

Sex

Male

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 TX

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

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.

• Lufkin Physician Services PA

  • Hospitalist Physician
  • Lufkin, TX
  • NPI 1881093789
  Medicare reassignment NPD
• Angelina Physician Services PA

  • Hospitalist Physician
  • Lufkin, TX
  • NPI 1417256025
  NPD (past)

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1124013552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 HEATH ST",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758352290",
            "telephone_number": "936-204-0600",
            "fax_number": "936-544-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 E LOOP 304",
            "address_2": "SUITE 200, ETMC RURAL HEALTH CLINIC",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351814",
            "telephone_number": "936-544-5132",
            "fax_number": "936-544-8029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONIDALA",
        "first_name": "RAVI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "M6981",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M6981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010424560001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Joseph Kelly, MD
• Deborah Ann Kennedy, M.S., R.D., L.D
• Kevin a Curran MD PA
• Ashley Nichole Knowles, APRN, FNP-C
• John Douglas Kolander, P.T.
• Mary Krug, CCC-SLP
• Brooke Alison Kuza, M.S., CCC-SLP
• Lifeguard Ambulance Service of Texas, LLC
• Meagan Linton-Defrance, MSN, APRN, FNP-C
• Lol Dental

• Family Medicine Physician in Crockett, TX
• Providers in Crockett, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.