NPIMap

Individual provider Active NPI

Pavan Devulapally, MD

  • Nephrology Physician
  • San Antonio, TX
National Provider Identifier
1306085477
Registry record updated Jul 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
P9550 Issued in TX
Practice address
4511 NW Loop 410
Suite 104
San Antonio, TX 78229-5124
Phone
(210) 614-7900
Fax
(210) 615-1211
NPI assigned
Feb 13, 2009
Last updated
Jul 29, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X P9550 TX
Nephrology Physician 207RN0300X P9550 TX Primary

Addresses

Primary practice location

4511 NW Loop 410
Suite 104
San Antonio, TX 78229-5124

Mailing address

PO Box 504152
Saint Louis, MO 63150-4152
Phone (210) 212-8622

Other practice location 1

205 22nd St
Hondo, TX 78861-2520
Phone (210) 614-7900

Other practice location 2

19910 Interstate 35 S Ste 102
Lytle, TX 78052-3547
Phone (210) 614-7900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140722000629 TX Practitioner - NephrologyPractitioner - Internal Medicine 7810165479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
M Reza Mizani MD PAGroup PAC ID 5294709689, 28 clinicians

Practice addresses (Care Compare)

19910 Interstate 35 S
Suite 102
Lytle, TX 78052-3547
Phone (210) 614-7900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P9550TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
M. Reza Mizani, M.D., P.a. Nephrology CurrentSince Jul 2, 2014 Accepting new patients
M. Reza Mizani, M.D., P.a. CurrentSince Jul 2, 2014 Accepting new patients

Locations

1595 S Main St
Ste 107
Boerne, TX 78006
Phone (830) 815-5555

1250 State Highway 173 N
Devine, TX 78016
Phone (210) 403-7978

205 22nd St
Hondo, TX 78861
Phone (830) 426-2753

19910 Interstate 35 S
Ste 102
Lytle, TX 78052

215 N San Saba
Ste 301
San Antonio, TX 78207
Phone (210) 212-8984

343 W Houston St
Ste 609
San Antonio, TX 78205
Phone (210) 212-4595

4511 NW Loop 410
Ste 104
San Antonio, TX 78229

8115 Datapoint Dr
Ste 200
San Antonio, TX 78229

Interoperability endpoints

  • Direct secure messaging: pavan.devulapally@strcg.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1306085477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504152",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631504152",
            "telephone_number": "210-212-8622",
            "fax_number": "210-212-9197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 NW LOOP 410",
            "address_2": "SUITE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295124",
            "telephone_number": "210-614-7900",
            "fax_number": "210-615-1211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 22nd St",
            "address_purpose": "LOCATION",
            "city": "Hondo",
            "state": "TX",
            "postal_code": "788612520",
            "country_code": "US",
            "telephone_number": "210-614-7900",
            "fax_number": "210-615-1211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19910 Interstate 35 S Ste 102",
            "address_purpose": "LOCATION",
            "city": "Lytle",
            "state": "TX",
            "postal_code": "780523547",
            "country_code": "US",
            "telephone_number": "210-614-7900",
            "fax_number": "210-615-1211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVULAPALLY",
        "first_name": "PAVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-13",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "P9550",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "P9550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.