NPIMap

Organization Active NPI

Srisai P C

Doing business as Anuradha Kollipara, MD

  • Internal Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1609019900
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01046950 Issued in IN
Legal business name
SRISAI P C
Doing business as
Anuradha Kollipara, MD
Practice address
7972 West Jefferson Blvd
Suite a
Fort Wayne, IN 46804-4140
Phone
(260) 459-1780
Fax
(260) 459-2779
NPI assigned
Apr 16, 2009
Last updated
Mar 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Authorized official

Name
Anuradha Kollipara, M.D.NPI 1871523787
Title
Owner
Phone
(260) 459-1780

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 01046950 IN Primary

Addresses

Primary practice location

7972 West Jefferson Blvd
Suite a
Fort Wayne, IN 46804-4140

Mailing address

7972 West Jefferson Blvd
Suite a
Fort Wayne, IN 46804-4140
Phone (260) 459-1780

Other names 1

  • Anuradha Kollipara, MD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090416000180 IN Part B Supplier - Clinic/Group Practice 8325195944 Receives reassigned benefits from 5 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

7972 W Jefferson Blvd
Ste A
Fort Wayne, IN 46804
Phone (260) 436-0281

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1609019900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7972 WEST JEFFERSON BLVD",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-459-1780",
            "fax_number": "260-459-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7972 WEST JEFFERSON BLVD",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-459-1780",
            "fax_number": "260-459-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRISAI P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-16",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "KOLLIPARA",
        "authorized_official_first_name": "ANURADHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-459-1780",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01046950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anuradha Kollipara, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.