Active NPI
Anil Kumar Reddy Manda, DMD
- Dentist
- Evansville, IN
National Provider Identifier
1528223054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011176A
- Practice address
- 5020 West Lloyd Expwy
Ste 200
Evansville,, IN 47712 - Phone
- (812) 463-8000
- Fax
- (812) 463-8104
- NPI assigned
- Jul 24, 2008
- Last updated
- Jul 24, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12011176A | IN | Primary |
Addresses
Primary practice location
5020 West Lloyd Expwy
Ste 200
Evansville,, IN 47712
Mailing address
PO Box 3189
Syracuse, NY 13220
Phone (866) 273-8204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406000699 | MD | Order and Referring Only - Other (Physician) | 7012215155 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15621 | MD | MD | School Psychologist |
| 12011176A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216857600000",
"number": "1528223054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3189",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13220",
"telephone_number": "866-273-8204",
"fax_number": "866-803-4943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5020 WEST LLOYD EXPWY",
"address_2": "STE 200",
"city": "EVANSVILLE,",
"state": "IN",
"postal_code": "47712",
"telephone_number": "812-463-8000",
"fax_number": "812-463-8104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDA",
"first_name": "ANIL KUMAR REDDY",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-24",
"last_updated": "2008-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011176A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.