Shylashree Chikkamuniyappa Edalur, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

M3188 Issued in TX

Practice address

1026 Riverwood Dr
Longview, TX 75604-6229

Phone

(903) 239-3862

NPI assigned

Aug 21, 2006

Last updated

Dec 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Pathology

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baylor College of MedicineGroup PAC ID 8527956176, 47 clinicians

Ameripath Lubbock 501a CorporationGroup PAC ID 5890690085, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Arlington Memorial Hospital Hospital, Arlington, TX, CCN 450064
• Usmd Hospital at Arlington L P Hospital, Arlington, TX, CCN 450872
• Texas Health Heart & Vascular Hospital Arlington Hospital, Arlington, TX, CCN 670071

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ameripath Lubbock 501a Corporation

  • Anatomic Pathology & Clinical Pathology Physician
  • Lubbock, TX
  • NPI 1134190705
  Medicare reassignment Care Compare group NPD
• Baylor College of Medicine

  dba Community Pathology Associates

  • Anatomic Pathology & Clinical Pathology Physician
  • Pasadena, TX
  • NPI 1316921026
  Medicare reassignment Care Compare group NPD
• Ameripath Lubbock 5.01(a) Corporation

  • Anatomic Pathology & Clinical Pathology Physician
  • Arlington, TX
  • NPI 1962508267
  NPD
• Baylor Pathology

  • Specialist
  • Houston, TX
  • NPI 1114032737
  NPD (past)
• Baylor Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Houston, TX
  • NPI 1386723658
  NPD (past)

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

• Amh Cath Labs LLC

  dba Texas Health Heart & Vascular Hospital Arlington

  • Special Hospital
  • Arlington, TX
  • NPI 1407169196
  Care Compare affiliation
• Texas Health Arlington Memorial Hospital

  • General Acute Care Hospital
  • Arlington, TX
  • NPI 1174533343
  Care Compare affiliation
• Usmd Hospital at Arlington, LLC

  • General Acute Care Hospital
  • Arlington, TX
  • NPI 1659352987
  Care Compare affiliation

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1609981174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 RIVERWOOD DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756046229",
            "telephone_number": "903-239-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 RIVERWOOD DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756046229",
            "telephone_number": "903-239-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDALUR",
        "first_name": "SHYLASHREE",
        "middle_name": "CHIKKAMUNIYAPPA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "M3188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN PERMIT",
            "identifier": "M3188",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East TX LLC
• Easttexrx LLC (Spring Hill Pharmacy)
• Lacy Kennedy Eaton, PA
• Myra Tan Echave, PT
• Ravikumar Hanumanthaiah Edalur, M.D
• Carlita Eddington, LMT
• Edu-Dula, Inc. (The Pediatric Rehab Center)
• Educare Community Living Corporation - Texas
• Educare Community Living Corporation - Texas
• Educare Community Living Corporation - Texas (All Ways Caring HomeCare)

• Anatomic Pathology & Clinical Pathology Physician in Longview, TX
• Providers in Longview, TX by specialty
• Anatomic Pathology & Clinical Pathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.
• 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.