Anitha Peddireddy, MDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12331 Issued in MN

Practice address

101 Martin Luther King Dr
Mankato, MN 56001-6460

Phone

(507) 594-6500

NPI assigned

May 29, 2007

Last updated

Feb 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mayo Clinic Health System-Southwest Minnesota Region

  dba Mayo Clinic Health System - Mankato

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  dba Mayo Clinic Health System-Waseca

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD
• Apple Tree Dental

  • General Practice Dentistry
  • Hawley, MN
  • NPI 1346301454
  NPD (past)

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1407057664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MARTIN LUTHER KING DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016460",
            "telephone_number": "507-594-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Main St",
            "address_purpose": "LOCATION",
            "city": "Hawley",
            "state": "MN",
            "postal_code": "565490849",
            "country_code": "US",
            "telephone_number": "218-483-1038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDDIREDDY",
        "first_name": "ANITHA",
        "credential": "MDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apeddireddy630627@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "101 Martin Luther King Dr",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560016460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tonya Jane Paulsen, PT
• Katie Paulson
• Kimberly Diane Pavlisich
• Jordan Noelle Pawelk, PMHNP
• Susan E Pearson, MD
• Jonathan Pedersen, PHYSICIAN ASSISTANT
• Glen Pederson-Linn
• Philip Andrew Pederson, PHARMD
• Pediatric and Adolescent Dentistry
• Pediatric Therapy Services Inc

• General Practice Dentistry in Mankato, MN
• Providers in Mankato, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.