Active NPI
Sudeep Mutyala
- Student in an Organized Health Care Education/Training Program
- Bethlehem, PA
National Provider Identifier
1336843903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 801 Ostrum St
Bethlehem, PA 18015-1000 - Phone
- (484) 526-4644
- Fax
- (833) 828-1813
- NPI assigned
- Mar 28, 2023
- Last updated
- Mar 28, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
801 Ostrum St
Bethlehem, PA 18015-1000
Mailing address
8777 Grady Dr
Breinigsville, PA 18031-4106
Phone (661) 428-4622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231219003321 | PA | Order and Referring Only - Internal Medicine | 2264882042 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1336843903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8777 GRADY DR",
"city": "BREINIGSVILLE",
"state": "PA",
"postal_code": "180314106",
"telephone_number": "661-428-4622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 OSTRUM ST",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180151000",
"telephone_number": "484-526-4644",
"fax_number": "833-828-1813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTYALA",
"first_name": "SUDEEP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-28",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.