NPIMap

Individual provider Active NPI

Paul R Ponnaiya, M.D.

  • Internal Medicine Physician
  • Rock Hill, SC
National Provider Identifier
1528059672
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10806 Issued in NV
Practice address
1795 Dr Frank Gaston Blvd
Rock Hill, SC 29732-1190
Phone
(702) 256-3637
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10806 NV Primary

Addresses

Primary practice location

1795 Dr Frank Gaston Blvd
Rock Hill, SC 29732-1190

Mailing address

3022 S Durango Dr Ste 100
Las Vegas, NV 89117-4440
Phone (702) 256-3637

Other identifiers 1

IdentifierTypeStateIssuer
1528059672MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040630000770 NV Practitioner - Internal Medicine 1052398898 Reassigns benefits to 1 organization
I20151221002655 SC Practitioner - Internal Medicine 1052398898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1795 Doctor Frank Gaston Blvd
Rock Hill, SC 29732-1190
Phone (803) 326-3500

Hospital & facility affiliations

  • Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002
  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195
  • Encompass Health Rehabilitation Hospital of Rock H Inpatient rehabilitation facility, Rock Hill, SC, CCN 423028
  • Encompass Health Rehabilitation Hospital Fort Mill Inpatient rehabilitation facility, Fort Mill, SC, CCN 423037

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Shiranee Jayasooriya Inc CurrentSince Mar 1, 2015 Accepting new patients
Maity Medical Associates Inc PastSince Mar 1, 2015 Accepting new patients
Zenith Hospitalists Billakanti and Janapati LLP Internal Medicine PastSince Apr 1, 2005 Accepting new patients
Inpatient Consultants of Nevada, Inc. a Medical Corporation Internal Medicine Past Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Family Medicine Past Accepting new patients
Lakeside Medical Organization, a Medical Group Inc. Family Medicine Past Accepting new patients

Locations

5400 S Rainbow Blvd
Las Vegas, NV 89118
Phone (702) 252-7342

2250 E Flamingo Rd
Las Vegas, NV 89119
Phone (702) 474-0200

3022 S Durango Dr
Ste 100
Las Vegas, NV 89117
Phone (702) 210-9423

8224 W Charleston Blvd
Ste 2
Las Vegas, NV 89117

8224 W Charleston Blvd
Las Vegas, NV 89117

1795 Frank Gaston Blvd
Rock Hill, SC 29732
Phone (516) 849-8385

Organizations & group practices 7

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 12

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1528059672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3022 S DURANGO DR STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891174440",
            "telephone_number": "702-256-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 DR FRANK GASTON BLVD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321190",
            "telephone_number": "702-256-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNAIYA",
        "first_name": "PAUL",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "10806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528059672",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.