NPIMap

Individual provider Active NPI

Lankala Rajendra Reddy, MD

  • Pediatrics Physician
  • Stockbridge, GA
National Provider Identifier
1174524581
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
047648 Issued in GA
Practice address
150 Medical Blvd
Ste B
Stockbridge, GA 30281-5053
Phone
(770) 389-9944
Fax
(770) 389-1973
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 047648 GA Primary

Addresses

Primary practice location

150 Medical Blvd
Ste B
Stockbridge, GA 30281-5053

Mailing address

150 Medical Blvd
Ste B
Stockbridge, GA 30281-5053
Phone (770) 389-9944

Other identifiers 18

IdentifierTypeStateIssuer
581487734OtherPROMINA CLAIMS
7483096OtherAETNA
782949OtherBCBS
581487734OtherPROMINA
581487734OtherPRINCIPAL
581487734OtherMETRAHEALTH
8563OtherKAISER
2335725OtherAETNA SELECT US HEALTHC
581487734OtherHMO CIGNA
581487734OtherONE HEALTH PLAN
581487734OtherUNICARE
581487734OtherPREFERRED PLAN
581487734OtherOXFORD HEALTHCARE
782949OtherFEP BLUE CROSS BLUE SHIEL
581487734OtherPHCS
581487734OtherPREFERRED HEALTH NETWORK
1200384OtherUNITED HEALTHCARE
581487734OtherGENERAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
047648GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Crescent Pediatrics PC Pediatrics Past Accepting new patients
Southern Crescent Pediatrics PC Pediatrics Past Accepting new patients
Southern Crescent Pediatrics PC Pediatrics Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1174524581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MEDICAL BLVD",
            "address_2": "STE B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815053",
            "telephone_number": "770-389-9944",
            "fax_number": "770-389-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MEDICAL BLVD",
            "address_2": "STE B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815053",
            "telephone_number": "770-389-9944",
            "fax_number": "770-389-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "LANKALA",
        "middle_name": "RAJENDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "047648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROMINA CLAIMS",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7483096",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "782949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROMINA",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRINCIPAL",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METRAHEALTH",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "8563",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA SELECT US HEALTHC",
            "identifier": "2335725",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO CIGNA",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONE HEALTH PLAN",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED PLAN",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTHCARE",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEP BLUE CROSS BLUE SHIEL",
            "identifier": "782949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED HEALTH NETWORK",
            "identifier": "581487734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1200384",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL",
            "identifier": "581487734",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.