Pooja Dhananjayan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101251399 Issued in VA

Practice address

1602 Rock Prairie Rd Ste 300
College Station, TX 77845-8309

Phone

(979) 695-3400

Fax

(979) 693-2845

NPI assigned

Jun 15, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

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.

• Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1558308825

  AZ

  Medicare reassignment NPD
• Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1386452415
  NPD
• Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1669878567
  NPD
• Banner - University Medical Center Phoenix

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1841224870
  NPD (past)
• Mountain Park Health Center - Dental

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1710146188
  NPD (past)
• Union Mill Pediatrics,PC

  • Legal Medicine
  • Centreville, VA
  • NPI 1114091931
  NPD (past)

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

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1497982789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD STE 300",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458309",
            "telephone_number": "979-695-3400",
            "fax_number": "979-693-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD STE 300",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458309",
            "telephone_number": "979-695-3400",
            "fax_number": "979-693-2845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13880 Braddock Rd",
            "address_2": "Suite #201",
            "address_purpose": "LOCATION",
            "city": "Centreville",
            "state": "VA",
            "postal_code": "201212459",
            "country_code": "US",
            "telephone_number": "703-802-6304",
            "fax_number": "703-802-6307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DHANANJAYAN",
        "first_name": "POOJA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116021905",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101251399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dept of Assistive & Rehab Serv - Bryan Field Office
• Angela Ellis Derbes, O.D.
• Averi Derrick
• Ashley Desimone
• Jessica Dever, LPC, LMFT, LCDC
• Alyssa Renee Diaz
• Kyle Russell Diblasi
• Samuel Wendell Dickerson, DO
• Katie Lynn Dickey
• Alexandra Dickinson

• All providers in College Station, TX
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.