Active NPI
Sundara C Nalla, M.D.
- Family Medicine Physician
- Fairmont, MN
National Provider Identifier
1548353022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 32815
- Practice address
- 229 Sylvan Dr
Fairmont, MN 56031-2421 - Phone
- (507) 749-0111
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 32815 | MN | Primary |
Addresses
Primary practice location
229 Sylvan Dr
Fairmont, MN 56031-2421
Mailing address
229 Sylvan Dr
Fairmont, MN 56031-2421
Phone (507) 749-0111
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115527 | Other | FM | UCARE |
| 0D930NA | Other | MN | BCBS MPIN |
| 080120227 | Other | MN | RR MEDICARE |
| 950797300 | Medicaid | MN | |
| 1967802 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- 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 |
|---|---|---|---|---|
| I20180117002791 | SD | Order and Referring Only - Family Practice | 6901970326 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- sundara.nalla@avera.sdhealthlink.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638230400000",
"number": "1548353022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 SYLVAN DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560312421",
"telephone_number": "507-749-0111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 SYLVAN DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560312421",
"telephone_number": "507-749-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NALLA",
"first_name": "SUNDARA",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2021-11-30",
"certification_date": "2021-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "32815",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "115527",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MPIN",
"identifier": "0D930NA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "080120227",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "950797300",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1967802",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; 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.