Individual provider Active NPI

Purnachander Rao Sirikonda, MD

  • Pediatrics Physician
  • Arlington, TX
National Provider Identifier
1629219407
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R8991 Issued in TX
Practice address
4907 S Collins St Ste 141
Arlington, TX 76018-1159
Phone
(817) 417-9001
Fax
(817) 417-9008
NPI assigned
Mar 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R8991 TX Primary

Addresses

Primary practice location

4907 S Collins St Ste 141
Arlington, TX 76018-1159

Mailing address

4907 S Collins St Ste 141
Arlington, TX 76018-1159
Phone (817) 417-9001

Other identifiers 1

IdentifierTypeStateIssuer
3918591MedicaidTX

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20051228000326 NJ Practitioner - Pediatric Medicine 8729000252 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Touch Pediatrics PLLC Pediatrics CurrentSince Feb 16, 2020 Accepting new patients
Emergency Physician Services of New Jersey,Professional Association CurrentSince Jun 1, 2018 Accepting new patients
Lamington Pediatrics, PC Pediatrics Past Accepting new patients

Locations

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

4907 S Collins St
Ste 141
Arlington, TX 76018
Phone (817) 417-9001

4907 S Collins St
Arlington, TX 76018

4645 Wyndham Ln
Ste 230
Frisco, TX 75033
Phone (469) 473-4120

6853 Coit Rd
Ste 300
Plano, TX 75024
Phone (972) 643-0736

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1236556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1629219407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4907 S COLLINS ST STE 141",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760181159",
            "telephone_number": "817-417-9001",
            "fax_number": "817-417-9008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4907 S COLLINS ST STE 141",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760181159",
            "telephone_number": "817-417-9001",
            "fax_number": "817-417-9008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRIKONDA",
        "first_name": "PURNACHANDER",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-09",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R8991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3918591",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.