Active NPI
Ramachandra Kolluru, MD
- Cardiovascular Disease Physician
- Odessa, TX
National Provider Identifier
1528065893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- J0555
- Practice address
- 420E6Th Street
Odessa, TX 79761-4537 - Phone
- (432) 685-3333
- Fax
- (432) 570-5440
- NPI assigned
- Jul 1, 2005
- Reactivated
- Mar 31, 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 |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | J0555 | TX | Primary |
Addresses
Primary practice location
420E6Th Street
Odessa, TX 79761-4537
Mailing address
5 Santa Maria CT
Odessa, TX 79765-8515
Phone (432) 685-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135590104 | Medicaid | TX |
Other names 1
- Ramachandra Rao Kolluru
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090428000316 | TX | Practitioner - Internal Medicine | 0749190247 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1974
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
420 E 6TH St
102 Permian Heart Clinic
Odessa, TX 79761-4537
Phone (432) 685-3333
Hospital & facility affiliations
- Midland Memorial Hospital
- Medical Center Hospital
- Odessa Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J0555 | TX | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ector County Hospital District | Past | Accepting new patients | |
| Midland County Hospital District | Past | Accepting new patients | |
| Odessa Regional Hospital LP | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Urgent Care Clinic/Center
- Odessa, TX
- NPI 1366680555
-
- General Acute Care Hospital
- Midland, TX
- NPI 1255325817
-
- General Acute Care Hospital
- Odessa, TX
- NPI 1801852736
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Federally Qualified Health Center (FQHC)
- Odessa, TX
- NPI 1578265302
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1528065893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 SANTA MARIA CT",
"city": "ODESSA",
"state": "TX",
"postal_code": "797658515",
"telephone_number": "432-685-3333",
"fax_number": "432-570-5440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420E6TH STREET",
"city": "ODESSA",
"state": "TX",
"postal_code": "797614537",
"telephone_number": "432-685-3333",
"fax_number": "432-570-5440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLLURU",
"first_name": "RAMACHANDRA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-01",
"last_updated": "2015-10-21",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "TX",
"license": "J0555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135590104",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "RAMACHANDRA",
"last_name": "KOLLURU",
"middle_name": "RAO",
"credential": "M.D",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.