Praveen Jayakumar, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15182 Issued in NV

Practice address

777 N Rainbow Blvd Ste 350
Las Vegas, NV 89107-1188

Phone

(480) 494-2465

NPI assigned

Jul 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV, IL, VT3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Culinary Extra Clinic

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1801295712
  NPD (past)

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1235337486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 E RIVULON BLVD STE 210",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970087",
            "telephone_number": "480-244-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAINBOW BLVD STE 350",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891071188",
            "telephone_number": "480-494-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYAKUMAR",
        "first_name": "PRAVEEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "15182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV MEDICAL LICENSE",
            "identifier": "15182",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Jax
• Rebecca Jax
• Jay a Johnson DDS LTD
• Jay Denton, DDS, PLLC
• Jay Noricks PHD PC
• Rebecca Ann Jayakumar, PHARMD, CPC-INTERN
• Vijay Jayaraman, M.D.
• Shiranee Jayasooriya, M.D.
• Jasmin Elaine Jayme
• Jaymes D. Granata, MD PLLC

• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.

Verify at the official NPI Registry.