Individual provider Active NPI

Ramana Kumar Puppala, M.D.

  • Gynecology Physician
  • Greenville, AL
National Provider Identifier
1669409629
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
70896 Issued in GA
Practice address
300 N College St
Greenville, AL 36037-2025
Phone
(334) 382-1015
Fax
(334) 382-1039
NPI assigned
Jun 27, 2006
Last updated
Jan 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 036110928 IL
Gynecology Physician 207VG0400X 70896 GA Primary
Gynecology Physician 207VG0400X 29509 AL

Addresses

Primary practice location

300 N College St
Greenville, AL 36037-2025

Mailing address

300 N College St
Greenville, AL 36037-2025
Phone (334) 382-1015

Other identifiers 3

IdentifierTypeStateIssuer
036110928MedicaidIL
510-48849OtherALBCBS
1669409629 / 112701MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20150914001556 GA Practitioner - Obstetrics/Gynecology 7618992322 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29509ALMDGynecology Physician
70896GAMDGynecology Physician
036110928ILMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Regional Physicians Management Group, LLC CurrentSince Dec 1, 2021 Accepting new patients
Obhg Georgia, P.C. CurrentSince May 10, 2016 Accepting new patients
Prime Healthcare Foundation - Southern Regional, LLC Past Accepting new patients
LV Stabler Primary Care LLC Past Accepting new patients

Locations

1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

29 Upper Riverdale Rd SW
Ste 230
Riverdale, GA 30274
Phone (770) 268-6010

Interoperability endpoints

  • Direct secure messaging: ramana.puppala.1@15247.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1669409629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N COLLEGE ST",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360372025",
            "telephone_number": "334-382-1015",
            "fax_number": "334-382-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N COLLEGE ST",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360372025",
            "telephone_number": "334-382-1015",
            "fax_number": "334-382-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUPPALA",
        "first_name": "RAMANA",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": "036110928",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "70896",
            "primary": true
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "AL",
            "license": "29509",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110928",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "510-48849",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669409629 / 112701",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, AL

Sources for this page

Verify at the official NPI Registry.