Pradeep Gopala Reddy, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036110081 Issued in IL

Practice address

3412 Office Park Drive
Marion, IL 62959-1998

Phone

(618) 993-0404

Fax

(618) 993-1717

NPI assigned

Aug 17, 2006

Last updated

Jun 8, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11869/brand/1/csg/1/fhir/r4
• Direct secure messaging: pradeep.reddy.1@11869.direct.athenahealth.com
• Direct secure messaging: preddy01@yourcarecommunity.org
• Direct secure messaging: preddy13649@sih.direct-ci.com

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.

• Marion Diagnostic Center, LLC

  • Multi-Specialty Clinic/Center
  • Marion, IL
  • NPI 1366543084

  Pediatrics

  NPD (past)
• Pediatric Group LLC

  • Pediatrics Physician
  • Carbondale, IL
  • NPI 1023582038
  NPD (past)
• Pediatric Group LLC

  • Rural Health Clinic/Center
  • Marion, IL
  • NPI 1114129970

  Pediatrics

  NPD (past)
• Southern Illinois Medical Services, NFP

  dba SIH Medical Group

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1649384892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DRIVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591998",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DRIVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591998",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011462",
            "country_code": "US",
            "telephone_number": "618-549-0721",
            "fax_number": "618-529-0549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDDY",
        "first_name": "PRADEEP",
        "middle_name": "GOPALA",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036110081",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036110081",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "preddy13649@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 W Jackson Street",
            "address_2": "SIH Medical Group Neonatology",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629016290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amar Rawal, MD
• Joshme Rawal, APRN
• Emma Kate Ray, SLP
• Rci (WRS) Inc.
• Amanda Rae Reaney, MSPAS, PA-C
• Amy Reed
• Madison Reed, CRSS, MHP
• Laura Reedy, CRNA
• Linda K. Reid, CRNA
• Renal Life Link Inc (Marion Dialysis)

• Pediatrics Physician in Marion, IL
• Providers in Marion, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.