Active NPI
Suresh N Pathikonda, M.D.
- Pediatrics Physician
- Victoria, TX
National Provider Identifier
1508804121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- J8083
- Practice address
- 601 E Airline Rd
Victoria, TX 77901-3926 - Phone
- (361) 575-8500
- Fax
- (361) 575-8416
- NPI assigned
- Jun 4, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J8083 | TX | Primary |
Addresses
Primary practice location
601 E Airline Rd
Victoria, TX 77901-3926
Mailing address
601 E Airline Rd
Victoria, TX 77901-3926
Phone (361) 575-8500
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0039AZ | Other | TX | GROUP BCBS |
| 079684901 | Medicaid | TX | |
| 127014205 | Medicaid | TX | |
| 079684902 | Medicaid | TX | |
| 127014203 | Medicaid | TX | |
| 742777132 | Other | TX | TAX ID |
| 88071B | Other | TX | INDIVIDUAL BCBS |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J8083 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Airline Pediatrics, P.a. | Pediatrics | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270080000000",
"number": "1508804121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 E AIRLINE RD",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779013926",
"telephone_number": "361-575-8500",
"fax_number": "361-575-8416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 E AIRLINE RD",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779013926",
"telephone_number": "361-575-8500",
"fax_number": "361-575-8416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATHIKONDA",
"first_name": "SURESH",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-04",
"last_updated": "2010-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J8083",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP BCBS",
"identifier": "0039AZ",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "079684901",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127014205",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "079684902",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127014203",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "742777132",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL BCBS",
"identifier": "88071B",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victoria, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.