Kanti Sri Vittala, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

50690 Issued in AZ

Practice address

1400 S Dobson Rd
Mesa, AZ 85202-4707

Phone

(480) 412-5437

NPI assigned

Jul 13, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Satya S Vittala Former name

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Acute Medical Services 1 PC

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1154860674
  Medicare reassignment NPD
• Banner Physician Super Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1841573870
  Medicare reassignment NPD
• Banner Physician Super Specialists Arizona LLC

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
  • NPI 1386462810
  NPD
• Arizona Post-Acute Medical Services 1 PC

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1093254419
  NPD (past)
• Banner del E Webb Medical Center

  • General Acute Care Hospital
  • Sun City West, AZ
  • NPI 1588823553
  NPD (past)
• Banner Desert Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1720011810
  NPD (past)
• Banner Gateway Medical Center

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1699884858
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1669760468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 S VILLAS LN",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852868416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707",
            "telephone_number": "480-412-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITTALA",
        "first_name": "KANTI",
        "middle_name": "SRI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "50690",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A128129",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SATYA",
            "last_name": "VITTALA",
            "middle_name": "S",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vitalis Wellness Center of Phoenix, Az PC
• Vitality Med Spa
• Vitality Medspa, LLC.
• Armando Viterk
• Vito Anesthesia LLC
• Vivify Wellness LLC
• Kathleen Vize, OD
• Vjuv Corporate LLC
• Vjuvinate LLC
• VM Med

• Pediatrics Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.