NPIMap

Individual provider Active NPI

Vijaya R Pokala, M.D., F.A.C.C.

  • Interventional Cardiology Physician
  • Nacogdoches, TX
National Provider Identifier
1205847522
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
H6917 Issued in TX
Practice address
1023 N Mound St
Suite K
Nacogdoches, TX 75961-4491
Phone
(936) 564-2099
Fax
(936) 564-2083
NPI assigned
Aug 11, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H6917 TX
Interventional Cardiology Physician 207RI0011X H6917 TX Primary
Nuclear Cardiology Physician 207UN0901X L05982 TX

Addresses

Primary practice location

1023 N Mound St
Suite K
Nacogdoches, TX 75961-4491

Mailing address

1023 N Mound St
Suite K
Nacogdoches, TX 75961-4491
Phone (936) 564-2099

Other identifiers 4

IdentifierTypeStateIssuer
H6917OtherTXPHYSICIAN LICENSE/PERMIT
L05982OtherTXRADIOACTIVE MATERIAL LISC
C0073073OtherTXCONTROLLED SUBSTANCE REGI
179845601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20060501000511 TX Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 7012966047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1023 N Mound St
Suite K
Nacogdoches, TX 75961-4453
Phone (936) 564-2099

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting31
Pacemaker insertion or repair17
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L05982TXMDNuclear Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Texas Cardiovascular Labs LLC PastSince Jul 1, 1993 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: vpokala@118.securemail.prognocis.com

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1205847522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 N MOUND ST",
            "address_2": "SUITE K",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614491",
            "telephone_number": "936-564-2099",
            "fax_number": "936-564-2083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 N MOUND ST",
            "address_2": "SUITE K",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614491",
            "telephone_number": "936-564-2099",
            "fax_number": "936-564-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POKALA",
        "first_name": "VIJAYA",
        "middle_name": "R",
        "credential": "M.D., F.A.C.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2023-03-07",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H6917",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TX",
            "license": "H6917",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "TX",
            "license": "L05982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN LICENSE/PERMIT",
            "identifier": "H6917",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RADIOACTIVE MATERIAL LISC",
            "identifier": "L05982",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE REGI",
            "identifier": "C0073073",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179845601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

Verify at the official NPI Registry.