Individual provider Active NPI

Suma Nandakumar Raju, MD

  • Pediatric Gastroenterology Physician
  • Temple, TX
National Provider Identifier
1336280130
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
P3568 Issued in TX
Practice address
1901 SW H K Dodgen Loop BLDG 300
Temple, TX 76502-1814
Phone
(254) 724-5437
NPI assigned
Feb 12, 2007
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X P3568 TX
Pediatric Gastroenterology Physician 2080P0206X P3568 TX Primary

Addresses

Primary practice location

1901 SW H K Dodgen Loop BLDG 300
Temple, TX 76502-1814

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other names 1

  • Suma Nandakumar Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sraju14281@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120904000441 TX Practitioner - Pediatric Medicine 8123110145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Texas Tech University Health Science Center School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1901 SW H K Dodgen Loop
Temple, TX 76502-1814
Phone (254) 724-5437

1901 SW H K Dodgen LP BLDG
300 Baylor Scott and White McLane Childre
Temple, TX 76502-1814
Phone (254) 724-5437

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P3568TXMDPediatrics Physician
24557OKMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Pediatrics Current Accepting new patients
Scott & White Clinic Pediatrics CurrentSince Aug 12, 2012 Accepting new patients
Scott and White Clinic Pediatrics CurrentSince Aug 12, 2012 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

3801 Scott and White Dr
Killeen, TX 76543
Phone (254) 680-1100

1901 SW H K Dodgen Loop
Temple, TX 76502
Phone (254) 742-9256

1901 SW H K Dodgen Loop
Bldg 300
Temple, TX 76502
Phone (254) 935-4888

Interoperability endpoints

  • Direct secure messaging: sraju14281@direct.sw.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1336280130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SW H K DODGEN LOOP BLDG 300",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765021814",
            "telephone_number": "254-724-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJU",
        "first_name": "SUMA",
        "middle_name": "NANDAKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P3568",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TX",
            "license": "P3568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sraju14281@direct.sw.org",
            "affiliation": "N",
            "address_1": "1901 SW H K Dodgen Loop Bldg 300",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765021814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUMA",
            "last_name": "NANDAKUMAR",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.