NPIMap

Individual provider Active NPI

Prakash V Reddy, MD

  • Sleep Medicine (Internal Medicine) Physician
  • Indialantic, FL
National Provider Identifier
1528043163
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
License
ME83944 Issued in FL
Practice address
140 6TH Ave
Indialantic, FL 32903-3204
Phone
(321) 312-3501
Fax
(321) 723-9176
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X ME83944 FL Primary

Addresses

Primary practice location

140 6TH Ave
Indialantic, FL 32903-3204

Mailing address

3300 S Fiske Blvd
Rockledge, FL 32955-4306

Other identifiers 2

IdentifierTypeStateIssuer
272481200MedicaidFL
64150XOtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050630000749 FL Practitioner - Pulmonary DiseasePractitioner - Sleep Medicine 5395781207 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Sleep Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Health First Privia Medical Group 247 clinicians

Practice addresses (Care Compare)

140 6TH Ave
Indialantic, FL 32903-3204
Phone (321) 312-3501

Hospital & facility affiliations

  • Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
  • Palm Bay Hospital Hospital, Palm Bay, FL, CCN 100316
  • Viera Hospital Hospital, Melbourne, FL, CCN 100315
  • Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177

Merit-based Incentive Payment System (MIPS)

Final score
94.79 of 100Reported as apm
Quality
86.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME83944FLMDSleep Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KND Development 59, LLC CurrentSince Aug 28, 2011 Accepting new patients
Privia Medical Group Florida, LLC CurrentSince Jun 9, 2024 Accepting new patients
KND Development 59 LLC Current Accepting new patients
Coastal Pulmonary and Sleep Center LLC Sleep Medicine Current Accepting new patients
KND Development 59 LLC CurrentSince Aug 28, 2011 Accepting new patients

Locations

140 6th Ave
Indialantic, FL 32903
Phone (321) 312-3501

1223 Gateway Dr
Ste 2F
Melbourne, FL 32901
Phone (321) 312-3486

765 W Nasa Blvd
Melbourne, FL 32901
Phone (321) 409-4044

1223 Gateway Dr
Melbourne, FL 32901
Phone (321) 549-0677

3300 S Fiske Blvd
Rockledge, FL 32955
Phone (321) 434-1771

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958
Phone (727) 617-1777

3030 6th St S
St Petersburg, FL 33705
Phone (727) 894-8719

Interoperability endpoints

  • Direct secure messaging: prakash.reddy.2@8042.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1528043163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 6TH AVE",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329033204",
            "telephone_number": "321-312-3501",
            "fax_number": "321-723-9176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "PRAKASH",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "FL",
            "license": "ME83944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272481200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "64150X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indialantic, FL

Sources for this page

Verify at the official NPI Registry.