NPIMap

Individual provider Active NPI

Sailaja Tummala, MD

  • Family Medicine Physician
  • Lebanon, MO
National Provider Identifier
1174690630
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2011022971 Issued in MO
Practice address
755 Cowan Drive
Lebanon, MO 65536
Phone
(417) 532-2805
Fax
(417) 532-2865
NPI assigned
Nov 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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 2011022971 MO Primary

Addresses

Primary practice location

755 Cowan Drive
Lebanon, MO 65536

Mailing address

1622 W Caleb CT
Springfield, MO 65810-1525

Other practice location 1

1622 W Caleb Ct
Springfield, MO 65810-1525
Phone (417) 449-4154

Other identifiers 2

IdentifierTypeStateIssuer
35322100MedicaidWI
206520504MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20110907000785 MO Practitioner - Family Practice 5193819050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Regional Health SystemGroup PAC ID 9133026776, 132 clinicians

Practice addresses (Care Compare)

54 Hospital Dr
Osage Beach, MO 65065-3050

755 Cowan Dr
Lebanon, MO 65536-4629
Phone (417) 532-2805

Hospital & facility affiliations

  • Integrity Home Care + Hospice Home health agency, Springfield, MO, CCN 267576
  • Lake Regional Health System Hospital, Osage Beach, MO, CCN 260186

Merit-based Incentive Payment System (MIPS)

Final score
94.19 of 100Reported as group
Promoting interoperability
100
Improvement activities
40
Cost
75.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2011022971MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Regional Health System CurrentSince Apr 1, 2023 Accepting new patients
Lake Regional Health System Family Medicine CurrentSince Apr 1, 2023 Accepting new patients
Lake Regional Health System Current Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

226 E US Highway 54
Camdenton, MO 65020
Phone (573) 346-3700

304A E 4th St
Eldon, MO 65026
Phone (573) 392-5654

755 Cowan Dr
Lebanon, MO 65536
Phone (417) 532-2805

54 Hospital Dr
Osage Beach, MO 65065
Phone (573) 280-2772

Interoperability endpoints

  • Direct secure messaging: sailajatummala@mhccaremail.com

Organizations & group practices 4

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 6

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1174690630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 W CALEB CT",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658101525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 COWAN DRIVE",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "65536",
            "telephone_number": "417-532-2805",
            "fax_number": "417-532-2865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1622 W Caleb Ct",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658101525",
            "country_code": "US",
            "telephone_number": "417-449-4154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUMMALA",
        "first_name": "SAILAJA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2011022971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35322100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206520504",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.