Active NPI
Prasad K Peddu, M.D.
- Internal Medicine Physician
- Lufkin, TX
National Provider Identifier
1487656468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- J9263
- Practice address
- 515 Gaslight Blvd
Lufkin, TX 75904-3127 - Phone
- (936) 634-3995
- Fax
- (936) 634-4022
- NPI assigned
- Aug 10, 2005
- Last updated
- Aug 27, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | J9263 | TX | Primary |
Addresses
Primary practice location
515 Gaslight Blvd
Lufkin, TX 75904-3127
Mailing address
515 Gaslight Blvd
Lufkin, TX 75904-3127
Phone (936) 634-3995
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 261887122 | Other | TX | TAX ID |
| 038251701 | Medicaid | TX | |
| 110114826 | Other | TX | MEDICARE RAILROAD ID |
Other names 1
- Koteswara P Peddu
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Epic Internal Medicine PLLC | Internal Medicine | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Lufkin, TX
- NPI 1720667728
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440633600000",
"number": "1487656468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 GASLIGHT BLVD",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043127",
"telephone_number": "936-634-3995",
"fax_number": "936-694-4022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 GASLIGHT BLVD",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043127",
"telephone_number": "936-634-3995",
"fax_number": "936-634-4022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDDU",
"first_name": "PRASAD",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2015-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "J9263",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "261887122",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038251701",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD ID",
"identifier": "110114826",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KOTESWARA",
"last_name": "PEDDU",
"middle_name": "P",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.