Srividya Prabhu, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

10726 Issued in KY

Practice address

201 Martha Layne Collins Blvd Ste B
Cold Spring, KY 41076-1750

Phone

(859) 441-4805

NPI assigned

Aug 20, 2018

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

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: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 23, 2022 through Mar 23, 2028

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 and National Provider Directory roles.

• Southern Roots Perio Highland Heights

  • Dental Clinic/Center
  • Cold Spring, KY
  • NPI 1164152260
  NPD

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1477033371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MARTHA LAYNE COLLINS BLVD STE B",
            "city": "COLD SPRING",
            "state": "KY",
            "postal_code": "410761750",
            "telephone_number": "309-912-8794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MARTHA LAYNE COLLINS BLVD STE B",
            "city": "COLD SPRING",
            "state": "KY",
            "postal_code": "410761750",
            "telephone_number": "859-441-4805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRABHU",
        "first_name": "SRIVIDYA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "KY",
            "license": "10726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie J Petrushko, M.S. CCC-S-LP
• Julie D Piscitello, PT
• Nicole Ponting, MS CCC-SLP
• Jamie Potter, IECE
• Stephanie Lynn Poynter, SPEECH THERAPIST
• Prencoe Dialysis, LLC
• Prowellness Rehab Inc
• Publix Super Markets Inc
• Christine Reasoner, BS, COTA/L
• Fonda Reis, CSW

• All providers in Cold Spring, KY
• Periodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.

Verify at the official NPI Registry.