NPIMap

Organization Active NPI

Jay R Pudupakkam MD PA

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1205962289
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JAY R PUDUPAKKAM MD PA
Practice address
12221 Merit Dr
Suite 460
Dallas, TX 75251-2202
Phone
(469) 374-3850
Fax
(469) 374-3851
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Jay R Pudupakkam, MDNPI 1629086889
Title
MD Owner
Phone
(469) 374-3850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

12221 Merit Dr
Suite 460
Dallas, TX 75251-2202

Mailing address

12221 Merit Dr
Suite 460
Dallas, TX 75251-2202
Phone (469) 374-3850

Other identifiers 2

IdentifierTypeStateIssuer
177994401MedicaidTX
DE8671OtherTXMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1205962289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 460",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202",
            "telephone_number": "469-374-3850",
            "fax_number": "469-374-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 460",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202",
            "telephone_number": "469-374-3850",
            "fax_number": "469-374-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY R PUDUPAKKAM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "PUDUPAKKAM",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "469-374-3850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177994401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DE8671",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.