Individual provider Active NPI

Sri Haritha Vardhini Nekkanti, MD

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1184183980
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
U2586 Issued in TX
Practice address
5601 Loch Raven Blvd, Russell Morgan BDG,
3Rd Floor
Baltimore, MD 21239
Phone
(443) 444-5600
NPI assigned
Mar 19, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X D0095056 MD
Internal Medicine Physician 207R00000X U2586 TX Primary

Addresses

Primary practice location

5601 Loch Raven Blvd, Russell Morgan BDG,
3Rd Floor
Baltimore, MD 21239

Mailing address

PO Box 746079
Atlanta, GA 30374-6079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20240103003497 TX Practitioner - Internal Medicine 8921483470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

701 W 51St St
Mail Code E 619
Austin, TX 78751-2312

702 SW 8TH St
Bentonville, AR 72716-0445

702 SW 8TH St
Bentonville, AR 72716-6299

PO Box
Atlanta, GA 30374

PO Box
Suite 746079
Atlanta, GA 30374-6079

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0095056MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Human Services Commission CurrentSince Aug 21, 2023 Accepting new patients
Health and Human Services Commission Multi-Specialty Current Accepting new patients
Health and Human Services Commission Multi-Specialty CurrentSince Aug 21, 2023 Accepting new patients

Locations

2501 Maple St
Abilene, TX 79602
Phone (325) 692-4053

4001 Highway 36 S
Brenham, TX 77833
Phone (979) 277-1327

3980 State School Rd
Denton, TX 76210
Phone (940) 591-3341

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": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1184183980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746079",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 LOCH RAVEN BLVD, RUSSELL MORGAN BDG,",
            "address_2": "3RD FLOOR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21239",
            "telephone_number": "443-444-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEKKANTI",
        "first_name": "SRI HARITHA",
        "middle_name": "VARDHINI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0095056",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "U2586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.