NPIMap

Individual provider Active NPI

Prathima Vemuru Reddy, M.D.

  • Internal Medicine Physician
  • Wakefield, MA
National Provider Identifier
1669447298
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
71487 Issued in MA
Practice address
1 Walton Street
Wakefield, MA 01880
Phone
(781) 246-9131
Fax
(781) 246-9159
NPI assigned
Feb 17, 2006
Last updated
Feb 5, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71487 MA Primary

Addresses

Primary practice location

1 Walton Street
Wakefield, MA 01880

Mailing address

33 Chandler Rd
Boxford, MA 01921-1512
Phone (978) 561-1732

Other identifiers 8

IdentifierTypeStateIssuer
071487OtherMATUFTS
65035OtherMAHARVARD PILGRIM
3054420MedicaidMA
J09157OtherMABC/BS
73308OtherMAAFFORDABLE NETWORKS
0401419OtherMAUNITED HEALTHCARE
587634OtherMAAETNA
B10071201OtherMACIGNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060315000593 MA Practitioner - Internal MedicinePractitioner - General Practice 9739196775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: General Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Congenial Healthcare LLCGroup PAC ID 5395011522, 12 clinicians

Practice addresses (Care Compare)

1 Walton St
Wakefield, MA 01880-1209
Phone (781) 246-9113

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Congenial Healthcare, LLC CurrentSince Oct 1, 2017 Accepting new patients
Congenial Healthcare, LLC Internal Medicine CurrentSince Oct 1, 2017 Accepting new patients
Congenial Healthcare, LLC Internal Medicine Past Accepting new patients

Locations

1 Roosevelt Ave
Ste 201
Peabody, MA 01960
Phone (978) 536-0215

1 Walton St
Wakefield, MA 01880
Phone (781) 246-9113

Interoperability endpoints

  • Direct secure messaging: preddy92616@direct.bilh.masshiway.net

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202169600000",
    "number": "1669447298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 CHANDLER RD",
            "city": "BOXFORD",
            "state": "MA",
            "postal_code": "019211512",
            "telephone_number": "978-561-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WALTON STREET",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "01880",
            "telephone_number": "781-246-9131",
            "fax_number": "781-246-9159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "PRATHIMA",
        "middle_name": "VEMURU",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2008-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "71487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "071487",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "65035",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3054420",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "J09157",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AFFORDABLE NETWORKS",
            "identifier": "73308",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0401419",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "587634",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "B10071201",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

Verify at the official NPI Registry.