Active NPI
Sudhakar Reddy Morthala, M.D.
- Psychiatry Physician
- Elgin, SC
National Provider Identifier
1366456204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28478
- Practice address
- 2171 Highway 1 S
Elgin, SC 29045-9051 - Phone
- (803) 438-0455
- Fax
- (803) 438-0457
- NPI assigned
- Jul 28, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28478 | SC | Primary |
Addresses
Primary practice location
2171 Highway 1 S
Elgin, SC 29045-9051
Mailing address
2171 Highway 1 S
Elgin, SC 29045-9051
Phone (803) 438-0455
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28478 | Other | SC | MEDICAL LICENSE |
| 2028478 | Other | SC | SC CONTROLLED DRUG PERMIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1366456204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2171 HIGHWAY 1 S",
"city": "ELGIN",
"state": "SC",
"postal_code": "290459051",
"telephone_number": "803-438-0455",
"fax_number": "803-438-0457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2171 HIGHWAY 1 S",
"city": "ELGIN",
"state": "SC",
"postal_code": "290459051",
"telephone_number": "803-438-0455",
"fax_number": "803-438-0457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTHALA",
"first_name": "SUDHAKAR",
"middle_name": "REDDY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "28478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "28478",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC CONTROLLED DRUG PERMIT",
"identifier": "2028478",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elgin, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.