Active NPI
Srita Chundru
- Dentist
- Milwaukee, WI
National Provider Identifier
1225652712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1002292-15
- Practice address
- 1838 S 15TH St
Milwaukee, WI 53204-3225 - Phone
- (201) 889-7383
- NPI assigned
- Jun 1, 2020
- Last updated
- Jun 8, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1002292-15 | WI | Primary |
Addresses
Primary practice location
1838 S 15TH St
Milwaukee, WI 53204-3225
Mailing address
1400 N Lake Shore Dr Apt 10J
Chicago, IL 60610-1601
Phone (201) 889-7383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200831000485 | WI | Order and Referring Only - Dentist | 4082031422 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591574400000",
"number": "1225652712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 N LAKE SHORE DR APT 10J",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606101601",
"telephone_number": "201-889-7383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1838 S 15TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532043225",
"telephone_number": "201-889-7383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNDRU",
"first_name": "SRITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-01",
"last_updated": "2020-06-08",
"certification_date": "2020-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1002292-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.