Prasad Venkata Devabhaktuni, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

15587 Issued in WV

Practice address

14 E Grafton Rd
Suite C
Fairmont, WV 26554-4465

Phone

(304) 363-7773

Fax

(304) 363-7773

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Associated Specialists, Inc.

  • Infectious Disease Physician
  • Bridgeport, WV
  • NPI 1427165596
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1417027103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 E GRAFTON RD",
            "address_2": "SUITE C",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265544465",
            "telephone_number": "304-363-7773",
            "fax_number": "304-363-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 E GRAFTON RD",
            "address_2": "SUITE C",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265544465",
            "telephone_number": "304-363-7773",
            "fax_number": "304-363-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVABHAKTUNI",
        "first_name": "PRASAD",
        "middle_name": "VENKATA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WV",
            "license": "15587",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WV",
            "license": "15587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009095000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071632000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Derby
• Rebecca Desantis
• Rebecca S Deusenberry
• Babu R. Devabhakthuni, M.D.
• Ravi Chandra Devabhakthuni, PA-C
• Rebecca Devito
• Derek Dewitt, PT
• DHP of Fairmont Inc
• Amber Dias
• William B Dickey, MSQRPCRCLPC

• Pulmonary Disease Physician in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Pulmonary Disease Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.