Jaya Praveen Kumar Penagaluri

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M13830 Issued in ID

Practice address

105 W 8TH Ave Ste 450E
Spokane, WA 99204-2302

Phone

(509) 474-6920

Fax

(509) 474-3014

NPI assigned

Jul 17, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

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

Interoperability endpoints

• Direct secure messaging: jpenagaluri619813@wm.providencedirect.org

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.

• Brentwood Acquisition-Shreveport Inc.

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1164725701
  Medicare reassignment NPD
• Brentwood Acquisition-Shreveport Inc.

  • Psychiatric Hospital
  • Shreveport, LA
  • NPI 1417979204

  Psychiatry

  NPD

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1124258645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE STE 450E",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042302",
            "telephone_number": "509-474-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE STE 450E",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042302",
            "telephone_number": "509-474-6920",
            "fax_number": "509-474-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENAGALURI",
        "first_name": "JAYA PRAVEEN",
        "middle_name": "KUMAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-17",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M13830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpenagaluri619813@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "105 W 8th Ave Ste 450E",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992042302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpenagaluri627536@direct.multicare.org",
            "affiliation": "N",
            "address_1": "2003 Kootenai Health Way",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838146051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas R Pellow, MD
• Joseph Charles Peloso III, CP 61341135
• Christie Ann Pelz, LASW, MHP, CMHS
• Jennifer Pelzel
• Amy Marie Pemberton, DPT
• Stephen Penaskovic
• Asha Pence, M.S., CCC-SLP
• Jennifer L Pence, DPT
• Marisa Diane Pendergrass, LMP
• Jaylah Danielle Pendleton, LMSW

• Psychiatry Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; 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.