Guruprasad Tiptur Mahadevaiah, M.D.

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

V1910 Issued in TX

Practice address

333 N Santa Rosa
San Antonio, TX 78207-3108

Phone

(210) 704-3030

NPI assigned

Nov 3, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, TX2 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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: gtipturmahadevaiah15572@enloedirect.org
• Direct secure messaging: tmahadevaiah433505@christushealth.direct-ci.net
• Direct secure messaging: guruprasadtiptur.mahadevaiahmd.p1@direct.schc.nextgenshare.com
• Direct secure messaging: gtipturmahadevaiah390243@hisp.ehr.sutterhealth.org

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.

• Baylor College of Medicine

  • Pediatrics Physician
  • San Antonio, TX
  • NPI 1285079764
  Medicare reassignment NPD
• Capital Pediatric Cardiology Associates Inc

  • Pediatric Cardiology Physician
  • Sacramento, CA
  • NPI 1508211277
  Medicare reassignment NPD
• Christus Santa Rosa Health Care Corporation

  • General Acute Care Hospital
  • New Braunfels, TX
  • NPI 1114725033
  NPD (past)

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1265769806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N SAN SABA STE 1135",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073255",
            "telephone_number": "210-704-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N SANTA ROSA",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073108",
            "telephone_number": "210-704-3030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2929 K St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958165122",
            "country_code": "US",
            "telephone_number": "916-750-2328",
            "fax_number": "916-710-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIPTUR MAHADEVAIAH",
        "first_name": "GURUPRASAD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A152729",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "A152729",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "V1910",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "TX",
            "license": "V1910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14901846",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corrinna T Tiongson, M.D.
• Eswar Tipirneni
• Laurence W Tippin, CRNA
• Daniel R Tippit, MT
• Sophie T Tipton, PSY.D.
• Jose Tirado
• Regina Tirbeni, M.D.
• Hazel A Tiru, RN BSN
• Glen Edward Tisdale, LPC
• Taylor M Tisdale

• Pediatric Cardiology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Cardiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.