Individual provider Active NPI

Venkatakrishna Kakkilaya, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Dallas, TX
National Provider Identifier
1386855161
Registry record updated Oct 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
N9078 Issued in TX
Practice address
Department of Pediatrics
5323 Harry Hines Blvd
Dallas, TX 75390-9063
Phone
(214) 648-3903
Fax
(214) 648-2481
NPI assigned
May 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X N9078 TX Primary

Addresses

Primary practice location

Department of Pediatrics
5323 Harry Hines Blvd
Dallas, TX 75390-9063

Mailing address

Department of Pediatrics
5323 Harry Hines Blvd
Dallas, TX 75390-9063
Phone (214) 648-3903

Other identifiers 1

IdentifierTypeStateIssuer
280151602MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110823000630 TX Practitioner - Pediatric Medicine 6709901150 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2011 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2011 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients
Dallas County Hospital District Past Accepting new patients

Locations

2222 Welborn St
Dallas, TX 75219
Phone (214) 559-5000

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: venkat.kakkilaya@direct.swmed.us

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317945600000",
    "number": "1386855161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF PEDIATRICS",
            "address_2": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753909063",
            "telephone_number": "214-648-3903",
            "fax_number": "214-648-2481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF PEDIATRICS",
            "address_2": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753909063",
            "telephone_number": "214-648-3903",
            "fax_number": "214-648-2481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKKILAYA",
        "first_name": "VENKATAKRISHNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2011-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TX",
            "license": "N9078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280151602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.