NPIMap

Individual provider Active NPI

Sudheer Tangella, MD

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1124382536
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
836-L Issued in MS
Practice address
878 Lakeland Dr
Jackson, MS 39216-4644
Phone
(601) 984-6800
Fax
(601) 984-6811
NPI assigned
Jun 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 836-L MS Primary

Addresses

Primary practice location

878 Lakeland Dr
Jackson, MS 39216-4644

Mailing address

PO Box 4999
Jackson, MS 39296-4999
Phone (601) 984-5426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20151205000078 MS Practitioner - Family Practice 8527382415 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Foundation of Central Mississippi IncGroup PAC ID 1153216411, 274 clinicians

Practice addresses (Care Compare)

1225 N State St
Jackson, MS 39202-2064
Phone (601) 292-4261

401 Baptist Dr
Suite 104
Madison, MS 39110-2010
Phone (601) 973-1504

Hospital & facility affiliations

  • Mississippi Baptist Medical Center Hospital, Jackson, MS, CCN 250102
  • Baptist Medical Center-Leake Hospital, Carthage, MS, CCN 251315
  • Baptist Medical Center-Yazoo Hospital, Yazoo City, MS, CCN 251313
  • University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001
  • King'S Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057

Merit-based Incentive Payment System (MIPS)

Final score
78.38 of 100Reported as group
Quality
54.22
Promoting interoperability
100
Improvement activities
40
Cost
73.72

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi Baptist Medical Center, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Baptist Nutrition Clinic CurrentSince Oct 1, 2015 Accepting new patients
Mississippi Baptist Medical Center, Inc CurrentSince Jan 1, 2016 Accepting new patients
Medical Foundation of Central Ms Family Medicine CurrentSince Oct 1, 2015 Accepting new patients
Medical Foundation of Central Mississippi, Inc. Family Medicine Current Accepting new patients
Mississippi Baptist Medical Center, Inc. Current Accepting new patients
Mississippi Baptist Medical Center, Inc. Past Accepting new patients

Locations

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383

965 Ridge Lake Blvd
Ste 315
Memphis, TN 38120
Phone (877) 348-1281

Organizations & group practices 7

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 5

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": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1124382536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4999",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964999",
            "telephone_number": "601-984-5426",
            "fax_number": "601-984-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164644",
            "telephone_number": "601-984-6800",
            "fax_number": "601-984-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANGELLA",
        "first_name": "SUDHEER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "836-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.