Dr. Vijay Pethkar MD PLLC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

MD31687 Issued in TN

Legal business name

DR. VIJAY PETHKAR MD PLLC

Practice address

780 N Mount Juliet Rd
Mount Juliet, TN 37122-3323

Phone

(615) 758-9273

Fax

(615) 758-4821

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Vijay Pethkar, M.D.NPI 1669470555

Title

Owner

Phone

(615) 727-1963

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Vijay Pethkar MD PLLC Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vijay Pethkar, MD

  • Pulmonary Disease Physician
  • Mt Juliet, TN
  • NPI 1669470555
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675555200000",
    "number": "1356474415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 N MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371223323",
            "telephone_number": "615-758-9273",
            "fax_number": "615-758-4821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 N MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371223323",
            "telephone_number": "615-758-9273",
            "fax_number": "615-758-4821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. VIJAY PETHKAR MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-02-05",
        "certification_date": "2023-02-05",
        "status": "A",
        "authorized_official_last_name": "PETHKAR",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-727-1963",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TN",
            "license": "MD31687",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": "MD31687",
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "TN",
            "license": "MD31687",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3729715",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vijay Pethkar MD PLLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Vijay Pethkar MD PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pulmonary Disease Physician in Mount Juliet, TN
• Providers in Mount Juliet, TN by specialty
• Pulmonary Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.