Individual provider Active NPI

Ramya Shyamala Kamath, D.D.S.

  • Pediatric Dentistry
  • Austin, TX
National Provider Identifier
1679919849
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D11036 Issued in OR
Practice address
6618 Sitio del Rio Blvd Ste B102
Austin, TX 78730-1146
Phone
(512) 900-5437
NPI assigned
May 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X D11036 OR Primary

Addresses

Primary practice location

6618 Sitio del Rio Blvd Ste B102
Austin, TX 78730-1146

Mailing address

6618 Sitio del Rio Blvd Ste B102
Austin, TX 78730-1146
Phone (512) 900-5437

Other names 1

  • Dr. Ramya Shyamala Kanukollu Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150930002582 MO Order and Referring Only - DentistPractitioner - Dentist 6103134762

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D11036ORMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Pediatric Dentistry PLLC PastSince Dec 21, 2021 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1679919849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6618 SITIO DEL RIO BLVD STE B102",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787301146",
            "telephone_number": "512-900-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6618 SITIO DEL RIO BLVD STE B102",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787301146",
            "telephone_number": "512-900-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMATH",
        "first_name": "RAMYA",
        "middle_name": "SHYAMALA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAMYA",
            "last_name": "KANUKOLLU",
            "middle_name": "SHYAMALA",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.