Individual provider Active NPI

Lata Tavanandi Mundkur, M.D.

Internal Medicine Physician
Lowell, MA

National Provider Identifier

1487645248

Registry record updated Aug 9, 2011

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Lowell, MA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Internal Medicine PhysicianTaxonomy code 207R00000X
License: 58514 Issued in MA
Practice address: 817 Merrimack St
Second Floor
Lowell, MA 01854-3571
Phone: (978) 452-0672
NPI assigned: Nov 2, 2005
Sex: Female
Sole proprietor: Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Specialties & licenses 2

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	58514	MA
Internal Medicine Physician	207R00000X	58514	MA	Primary

Addresses

Primary practice location

817 Merrimack St
Second Floor
Lowell, MA 01854-3571

Mailing address

817 Merrimack St
Second Floor
Lowell, MA 01854-3571
Phone (978) 452-0672

Other identifiers 21

Identifier	Type	State	Issuer
0466975	Other	MA	AETNA US HEALTHCARE
1487645248	Other	MA	CELTICARE
4328196	Other	MA	AETNA
970357	Other	MA	NETWORK HEALTH
J06028	Other	MA	BLUE CROSS BLUE SHIELD
0017292	Other	MA	NEIGHBORHOOD HEALTH PLAN
043117888	Other	MA	FEDERAL TAX ID
058514	Other	MA	TUFTS HEALTH PLAN
04-3117888	Other	MA	COVENTRY
04-3117888	Other	MA	GREAT-WEST
04-3117888	Other	MA	MULTIPLAN
3015599	Medicaid	MA
0401929	Other	MA	UNITED HEALTH CARE
043117888	Other	MA	TRICARE-NORTH
22D0943104	Other	MA	CLIA
2449768	Other	MA	CIGNA
04-3117888	Other	MA	BEECH STREET
109517	Other	MA	GREAT-WEST (ONE HEALTH)
33756	Other	MA	UNICARE - HEALTHY START
45819	Other	MA	FALLON COMMUNITY
65438	Other	MA	HARVARD PILGRIM

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
58514	MA	MD	Internal Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Lata T. Mundkur MD		PastSince Oct 7, 1987	Accepting new patients

Interoperability endpoints

FHIR API: https://fhir-myrecord.cerner.com/r4/812e0a2c-a2ee-43b3-baef-01bf949ae18f/

Organizations & group practices 1

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.

Lata T. Mundkur MD
- Primary Care Clinic/Center
- Lowell, MA
- NPI 1285819508
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312848000000",
    "number": "1487645248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 MERRIMACK ST",
            "address_2": "SECOND FLOOR",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018543571",
            "telephone_number": "978-452-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 MERRIMACK ST",
            "address_2": "SECOND FLOOR",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018543571",
            "telephone_number": "978-452-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDKUR",
        "first_name": "LATA",
        "middle_name": "TAVANANDI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "58514",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "58514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "0466975",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CELTICARE",
            "identifier": "1487645248",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4328196",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "970357",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "J06028",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0017292",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL  TAX  ID",
            "identifier": "043117888",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS  HEALTH  PLAN",
            "identifier": "058514",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "04-3117888",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT-WEST",
            "identifier": "04-3117888",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "04-3117888",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3015599",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0401929",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE-NORTH",
            "identifier": "043117888",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "22D0943104",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2449768",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH STREET",
            "identifier": "04-3117888",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT-WEST (ONE HEALTH)",
            "identifier": "109517",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE - HEALTHY START",
            "identifier": "33756",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMMUNITY",
            "identifier": "45819",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD  PILGRIM",
            "identifier": "65438",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.