Dr Ajay Nellutla Inc

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

10766 Issued in NV

Legal business name

DR AJAY NELLUTLA INC

Practice address

3201 S Maryland Pkwy
Suite #100
Las Vegas, NV 89109-2441

Phone

(702) 649-8009

Fax

(702) 649-8049

NPI assigned

Nov 20, 2008

Organization subpart

No

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

Authorized official

Name

Ajay K Nellutla, MDNPI 1407913718

Title

President

Phone

(702) 649-8009

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

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.

• Ajay K. Nellutla, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1407913718
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285632000000",
    "number": "1356596134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 1304-1801 W.OLYMPIC BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911991304",
            "telephone_number": "702-938-0419",
            "fax_number": "702-939-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S MARYLAND PKWY",
            "address_2": "SUITE #100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092441",
            "telephone_number": "702-649-8009",
            "fax_number": "702-649-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR AJAY NELLUTLA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2010-09-28",
        "status": "A",
        "authorized_official_last_name": "NELLUTLA",
        "authorized_official_first_name": "AJAY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-649-8009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NV",
            "license": "10766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356596134",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Geriatric Medicine (Internal Medicine) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; 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.