Vasudeva M Bommanna, MD

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

K 3685 Issued in TX

Practice address

607 Russell Blvd
Suite ' B'
Nacogdoches, TX 75965-1247

Phone

(936) 559-7750

Fax

(936) 559-7807

NPI assigned

Jun 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 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

Specialty

Allergy/Immunology

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Pioneer Heart Care, P.a.

  • Primary Care Clinic/Center
  • Nacogdoches, TX
  • NPI 1275961666
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1477594836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 RUSSELL BLVD",
            "address_2": "SUITE ' B'",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651247",
            "telephone_number": "936-559-7750",
            "fax_number": "936-559-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 RUSSELL BLVD",
            "address_2": "SUITE ' B'",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651247",
            "telephone_number": "936-559-7750",
            "fax_number": "936-559-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMANNA",
        "first_name": "VASUDEVA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "TX",
            "license": "K 3685",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "TX",
            "license": "K 3685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE # FOR WEBSTER",
            "identifier": "612574",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS #",
            "identifier": "0020CF",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake G. Sinclair, DDS II, P.a.
• Tammy Blank, EXECUTIVE DIRECTOR
• BMW Healthcare, Inc
• Linda Stark Bobo, PHD, ATC, LAT
• William Parker Bobo, ATC, LAT
• Shauna Lynn Bond, COTA
• Bonita Creek Emergency Services PLLC
• Douglas Bowlin, PTA
• Misty Adams Bowlin
• Jennifer Boynton, MS, RD, LD

• Allergy Physician in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Allergy Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.