Active NPI
Prakash Pedapati
- Radiation Oncology Physician
- Rockford, IL
National Provider Identifier
1295753259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 036058366
- Practice address
- 3535 N Bell School Rd
Rockford, IL 61114 - Phone
- (779) 696-9400
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 036058366 | IL | Primary |
Addresses
Primary practice location
3535 N Bell School Rd
Rockford, IL 61114
Mailing address
PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036058366 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ppedapati661819@direct.uwhealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613952000000",
"number": "1295753259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 78866",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532788866",
"telephone_number": "779-696-7150",
"fax_number": "779-696-7342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 N BELL SCHOOL RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "61114",
"telephone_number": "779-696-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDAPATI",
"first_name": "PRAKASH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2021-02-22",
"certification_date": "2021-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IL",
"license": "036058366",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036058366",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ppedapati661819@direct.uwhealth.org",
"affiliation": "N",
"address_1": "3535 N Bell School Rd",
"city": "Rockford",
"state": "IL",
"country_code": "US",
"postal_code": "61114",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rockford, IL
- Charles D Pearson, O.D.
- Drew W Pearson, APN
- James Henry Peck, BC-HIS
- Tracy Barrett Peck, P.T.
- Jason Andrew Peckels, M.S.ED., L.P.C.
- Christine M Pedersen, MSPT
- Pediatric Associates of Rockford
- Pediatric Cardiology Associates of Northern Illinois SC
- Pediatric Dentistry of Northern Illinois LTD
- Pediatrix Medical Group of Illinois PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.