NPIMap

Organization Active NPI

Mallu Reddy, M.D. Inc.

  • Internal Medicine Physician
  • Pomona, CA
National Provider Identifier
1184821340
Registry record updated Feb 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A62958 Issued in CA
Legal business name
MALLU REDDY, M.D. INC.
Practice address
1196 N Park Ave
Pomona, CA 91768-3027
Phone
(909) 623-4050
NPI assigned
Jun 29, 2007
Last updated
Feb 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2013

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

Authorized official

Name
Mallu Reddy, MDNPI 1942278221
Title
Owner
Phone
(909) 294-9499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A62958 CA Primary

Addresses

Primary practice location

1196 N Park Ave
Pomona, CA 91768-3027

Mailing address

2431 Elizabeth CT
Upland, CA 91784-1311
Phone (909) 623-4050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080317000645 CA Part B Supplier - Clinic/Group Practice 8022193994 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: West Covina, CA; Upland, CA; San Dimas, CA; Pomona, CA; Glendora, CA; Covina, CA; Chino, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mallu Reddy MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1184821340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 ELIZABETH CT",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841311",
            "telephone_number": "909-623-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1196 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683027",
            "telephone_number": "909-623-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLU REDDY, M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "MALLU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-294-9499",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A62958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.