NPIMap

Individual provider Active NPI

Praneeth Kudaravalli, MD

  • Gastroenterology Physician
  • Reno, NV
National Provider Identifier
1629495973
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
26787 Issued in NV
Practice address
655 Sierra Rose Dr
Reno, NV 89511-2060
Phone
(775) 829-7600
NPI assigned
Mar 25, 2014
Last updated
Aug 24, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 88415 GA
Internal Medicine Physician 207R00000X 51420 KY
Gastroenterology Physician 207RG0100X DR.0073095 CO
Gastroenterology Physician 207RG0100X 26787 NV Primary
Hospitalist Physician 208M00000X 51420 KY
Hospitalist Physician 208M00000X 88415 GA

Addresses

Primary practice location

655 Sierra Rose Dr
Reno, NV 89511-2060

Mailing address

655 Sierra Rose Dr
Reno, NV 89511-2060
Phone (775) 829-6700

Other practice location 1

1120 15th St
Augusta, GA 30912-0004
Phone (706) 721-8623

Other practice location 2

2535 S Downing St Ste 410
Denver, CO 80210-5851
Phone (303) 260-2740

Other identifiers 1

IdentifierTypeStateIssuer
13994135OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, GA, CO3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170628003111 NV Practitioner - GastroenterologyPractitioner - Internal MedicinePractitioner - Hospitalist 4880911957 Reassigns benefits to 1 organization
I20220621002103 GA Practitioner - Internal MedicinePractitioner - Hospitalist 4880911957 Reassigns benefits to 2 organizations
I20240911002610 CO Practitioner - Gastroenterology 4880911957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health AssociatesGroup PAC ID 0547247082, 38 clinicians

Practice addresses (Care Compare)

655 Sierra Rose Dr
Reno, NV 89511-2060
Phone (775) 829-7600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy107
Upper gastrointestinal (GI) endoscopy for acid reflux142

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
88415GAMDInternal Medicine Physician
DR.0073095COMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Au Medical Associates Inc CurrentSince Jun 1, 2022 Accepting new patients
Portercare Adventist Health System Gastroenterology CurrentSince Sep 1, 2024 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Oct 1, 2023 Accepting new patients
Portercare Adventist Health System CurrentSince Jul 1, 2024 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Digestive Health Associates Gastroenterology CurrentSince Jan 1, 2025 Accepting new patients
Portercare Adventist Health System Current Accepting new patients
Au Medical Associates Inc CurrentSince Jun 1, 2022 Accepting new patients
Portercare Adventist Health System CurrentSince Jul 1, 2024 Accepting new patients

Locations

2535 S Downing St
Ste 410
Denver, CO 80210
Phone (303) 260-2740

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1120 15th St
Ste OR6000
Augusta, GA 30912
Phone (706) 721-3813

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

655 Sierra Rose Dr
Reno, NV 89511
Phone (775) 829-7600

Interoperability endpoints

  • Direct secure messaging: pkudaravalli33154@ukhcdirect.org
  • Direct secure messaging: pkudaravalli3644908@adventhealth.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1629495973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 SIERRA ROSE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112060",
            "telephone_number": "775-829-6700",
            "fax_number": "775-829-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 SIERRA ROSE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112060",
            "telephone_number": "775-829-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309120004",
            "country_code": "US",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2535 S Downing St Ste 410",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802105851",
            "country_code": "US",
            "telephone_number": "303-260-2740",
            "fax_number": "303-260-2741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUDARAVALLI",
        "first_name": "PRANEETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "88415",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "51420",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CO",
            "license": "DR.0073095",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NV",
            "license": "26787",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KY",
            "license": "51420",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "88415",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13994135",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.