Jay Pudupakkam, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

K4199 Issued in TX

Practice address

12221 Merit Dr Ste 460
Dallas, TX 75251-2245

Phone

(469) 374-3850

Fax

(469) 374-3851

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Ector County Hospital District

  • Urgent Care Clinic/Center
  • Odessa, TX
  • NPI 1366680555
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1629086889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR STE 460",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512245",
            "telephone_number": "469-374-3850",
            "fax_number": "469-374-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR STE 460",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512245",
            "telephone_number": "469-374-3850",
            "fax_number": "469-374-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUDUPAKKAM",
        "first_name": "JAY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K4199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141171205",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stevie Puckett-Perez, PH.D.
• Alysia Abigail Puckett
• Cory Puckett, LPC INTERN
• Austin Jeffrey Pucylowski, MD
• Sridhar A. Pudu, MD
• Mitzi Puebla
• Bao Nguyen Puente, MD
• Jessica Puente, DC
• Rosa Irene Puente, LPC-A
• Julian Puga Jr.

• Internal Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.

Verify at the official NPI Registry.