Prakash Giddaluri, MD, MPH

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

324787 Issued in LA

Practice address

1666 E Bert Kouns Industrial Loop Ste 105
Shreveport, LA 71105-5718

Phone

(318) 212-3520

Fax

(318) 212-3525

NPI assigned

Nov 15, 2007

Last updated

Nov 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 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

Specialty

Family Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WK Urgent Care Center-PierremontGroup PAC ID 8123016946, 39 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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

• WK Urgent Care Center-Pierremont

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1639115132
  Medicare reassignment Care Compare group NPD
• Pain Management Specialists

  dba Medical Practice

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1922617125
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1164603478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS INDUSTRIAL LOOP STE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055718",
            "telephone_number": "318-212-3520",
            "fax_number": "318-212-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS INDUSTRIAL LOOP STE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055718",
            "telephone_number": "318-212-3520",
            "fax_number": "318-212-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5503 N Fry Rd Ste 101A",
            "address_2": "DANNY JACKSON HEALTH CENTER",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "774495846",
            "country_code": "US",
            "telephone_number": "713-982-7071",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "903 W Martin St",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782070903",
            "country_code": "US",
            "telephone_number": "210-358-3441",
            "fax_number": "210-358-5944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIDDALURI",
        "first_name": "PRAKASH",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-15",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "PHY TEMP",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0788",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "324787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "8L0266",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195141001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chad Michael Gibson, MD
• Jenesis Raquel Gibson, LPC
• Kirk Gibson, MSN, RN, PCCN
• Shameka Gibson, MHS
• William Lee Gibson Jr., MD
• Jimmy Lamar Giddings, LBSW
• Jerome P Gigante
• Peridot Gilbert, PLPC
• Kimberly Kay Gilbreath, RPH
• Jacqueline M Gilcrease, M.S., PLPC

• Family Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.