NPIMap

Individual provider Active NPI

Naga Lakshmana Prasad Nidadavolu, M.D

  • Neuromuscular Medicine (Psychiatry & Neurology) Physician
  • Saint Cloud, FL
National Provider Identifier
1386835601
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084N0008X
License
ME109423 Issued in FL
Practice address
4745 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone
(407) 818-1664
Fax
(407) 818-1654
NPI assigned
Aug 5, 2007
Last updated
Jan 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Psychiatry & Neurology) Physician 2084N0008X ME109423 FL Primary

Addresses

Primary practice location

4745 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400

Mailing address

4745 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone (407) 818-1664

Other identifiers 2

IdentifierTypeStateIssuer
ME109423OtherFLFLORIDA MEDICAL BOARD
003957500MedicaidFL

Other names 1

  • Nagalakshmana Prasad Nidadavolu Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110920000024 FL Practitioner - Neurology 1557532710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

4745 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone (407) 818-1664

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
95
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME109423FLMDNeuromuscular Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Lake City Institute of Neurology PA Single Specialty Current Accepting new patients

Locations

4745 Old Canoe Creek Rd
Saint Cloud, FL 34769
Phone (321) 805-4787

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FAHDAD/Endpoint/FAHDAD
  • Direct secure messaging: nagalakshmana.nidadavolu@fion.eclinicaldirectplus.com
  • Direct secure messaging: nnidadavolu179019@orlandohealth.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1386835601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "407-818-1664",
            "fax_number": "407-818-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "407-818-1664",
            "fax_number": "407-818-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDADAVOLU",
        "first_name": "NAGA LAKSHMANA",
        "middle_name": "PRASAD",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "FL",
            "license": "ME109423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAL BOARD",
            "identifier": "ME109423",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003957500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NAGALAKSHMANA",
            "last_name": "NIDADAVOLU",
            "middle_name": "PRASAD",
            "credential": "M.D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Cloud, FL

Sources for this page

Verify at the official NPI Registry.