Srikanth Podaralla, M.D., M.B.A
Individual provider Active NPI Pediatrics Physician · San Angelo, TX
NPI 1629246731 · NPPES record last updated Jun 7, 2019
Key facts
- NPI
- 1629246731
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- N4674 (TX)
- Practice address
- 225 E Beauregard Ave
San Angelo, TX 76903-5920 - Phone
- (325) 658-1511
- NPI assigned
- Feb 12, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101215001037 | TX | Practitioner - Pediatric Medicine | 4385729078 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Business Administration, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regional Employee Assistance Program Inc | Current |
Accepting new patients | |
| Shannon Clinic | Pediatrics | Current |
Accepting new patients |
| Regional Employee Assistance Program Inc | Pediatrics | Current |
Accepting new patients |
| Shannon Clinic | Current |
Accepting new patients | |
| Regional Employee Assistance Program Inc | Pediatrics | Current | Accepting new patients |
| Shannon Medical Center | Past | Accepting new patients |
Locations
225 E Beauregard Ave
San Angelo, TX 76903
Phone (325) 245-4301
3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361
120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511
Interoperability endpoints
- spodaralla30860@shannonhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | N4674 | TX | Yes |
Addresses
Primary practice location
225 E Beauregard Ave
San Angelo, TX 76903-5920
Mailing address
225 E Beauregard Ave
San Angelo, TX 76903-5920
Phone (325) 245-4301
Other providers in San Angelo, TX
- Jessica Marie Pizzola
- Stephan Gene Pizzola
- Planned Parenthood of West Texas
- PM Management-San Angelo NC I LLC
- PM Management-San Angelo NC II LLC
- Lonnie M Pollard
- Amanda Leigh Pollitt
- Billy Cleave Pool
- Deborah Ann Pope
- Erika M. Popkin
All providers in San Angelo, TX · Pediatrics Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.