Vijayalaxmi Bogavelli, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD166266 Issued in OR

Practice address

9155 SW Barnes Rd
Ste 333
Portland, OR 97225-6625

Phone

(503) 216-5102

NPI assigned

Dec 11, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dr. Vijayalaxmi Juvvadi Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1568522233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "address_2": "STE 333",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-216-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGAVELLI",
        "first_name": "VIJAYALAXMI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OR",
            "license": "MD166266",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "95-01178",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD166266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500686948",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901479",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vbogavelli549347@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5251 NE Glisan St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972133052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VIJAYALAXMI",
            "last_name": "JUVVADI",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynette Michelle Boettger, LPN
• Pui Yi Boey, FRCSED
• Melinda Kaye Boffing, OTD
• Nika Saba Bogaert, LCSW
• Courtney Marie Bogart
• Donatella Bogdan, RN
• Lidiya Bogdan, LD
• Robyn Sue Bogden, PT
• Elizabeth Mary Bogdon, MA
• Haley Katherine Boge

• Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.