NPIMap

Individual provider Active NPI

Bhargava Krishna Nelluri

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1164047726
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MT221292 Issued in PA
Practice address
5501 Old York Rd
Philadelphia, PA 19141-3018
Phone
(484) 622-0959
NPI assigned
Jun 10, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT221292 PA Primary

Addresses

Primary practice location

5501 Old York Rd
Philadelphia, PA 19141-3018

Mailing address

5501 Old York Rd
Philadelphia, PA 19141-3018
Phone (484) 622-0959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230711004301 SC Practitioner - Internal Medicine 3779942552 Reassigns benefits to 1 organization
I20240708003762 IL Practitioner - Internal Medicine 3779942552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

4103 Water Tower Place
Mount Vernon, IL 62864
Phone (618) 899-3500

Hospital & facility affiliations

  • SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
  • LHC-Illinois Home Health Care Home health agency, Marion, IL, CCN 147716
  • Mederi Caretenders Home health agency, Mount Vernon, IL, CCN 147251
  • Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
  • SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034
  • Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
  • Hamilton Memorial Hospital Hospital, McLeansboro, IL, CCN 141326
  • Franklin Hospital Hospital, Benton, IL, CCN 141321

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT221292PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vitalen Inpatient Care, PC CurrentSince Jul 15, 2023 Accepting new patients
Vitalen Inpatient Care PC CurrentSince Jul 15, 2023 Accepting new patients
Physician Services Corporation of Southern Illinois Inc. Internal Medicine CurrentSince Jun 25, 2024 Accepting new patients

Locations

4103 N Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 899-3500

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

125 Commonwealth Dr
Greenville, SC 29615
Phone (864) 225-1800

1 Saint Francis Dr
Greenville, SC 29601
Phone (864) 225-1000

1 Saint Francis Dr
Fl 4
Greenville, SC 29601
Phone (864) 255-1401

Interoperability endpoints

  • Direct secure messaging: bnelluri509062@direct-ehr-ssmhc.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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1164047726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "484-622-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "484-622-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLURI",
        "first_name": "BHARGAVA",
        "middle_name": "KRISHNA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT221292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.