Nithyananda Pakkala, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD9916 Issued in TN

Practice address

630 Nuckolls Rd
Bolivar, TN 38008-1532

Phone

(731) 658-6011

Fax

(731) 658-9884

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Y.N. Pakkala Other name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: General Surgery

Education

Other, 1968

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• West Tennessee Healthcare Bolivar Hospital Hospital, Bolivar, TN, CCN 441320

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Yn Pakkala M.D, P.C

  • General Practice Physician
  • Bolivar, TN
  • NPI 1841555141
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bolivar General Hospital, Inc.

  dba West Tennessee Healthcare Bolivar Hospital

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262131200000",
    "number": "1578558607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-6011",
            "fax_number": "731-658-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-6011",
            "fax_number": "731-658-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAKKALA",
        "first_name": "NITHYANANDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2009-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD9916",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD9916",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "Y.N.",
            "last_name": "PAKKALA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Felix Chukwudi Nnaji, MD
• Nuckolls Drug Stores, Inc (Medical Arts Pharmacy)
• Nuckolls Drug Stores, Inc (Hudson Drug Store)
• James Kim Nuckolls, BS
• Keaton Overton
• Hope Caples Parker
• Anita Jo Parks, D.D.S.
• Chelsey Elizabeth Parks, NP
• Leslie Parnell, P.T.A.
• Anna Kate Perry, NP

• Family Medicine Physician in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; 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.

Verify at the official NPI Registry.