Individual provider Active NPI

Tejaswita Laxman Katta, M.D.

  • Internal Medicine Physician
  • Lakeland, FL
National Provider Identifier
1689163644
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME153127 Issued in FL
Practice address
1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543
Phone
(863) 687-1100
NPI assigned
May 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X ME153127 FL Primary

Addresses

Primary practice location

1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543

Mailing address

2260 Terra Cotta CV Apt 106
Land O Lakes, FL 34639-2870
Phone (267) 324-6306

Other names 1

  • Tejaswita Laxman Fulzele Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230515002480 FL Practitioner - Internal Medicine 8325404486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Care Hospitalists PLGroup PAC ID 5092753632, 66 clinicians

Practice addresses (Care Compare)

4315 Highland Park Blvd
Suite D
Lakeland, FL 33813-1639
Phone (863) 816-5884

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME153127FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Care Hospitalists PL CurrentSince May 1, 2023 Accepting new patients

Locations

4315 Highland Park Blvd
Ste D
Lakeland, FL 33813
Phone (863) 816-5884

1324 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 687-1132

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.

Hospital & facility affiliations 3

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": "1525478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1689163644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 TERRA COTTA CV APT 106",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346392870",
            "telephone_number": "267-324-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054543",
            "telephone_number": "863-687-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATTA",
        "first_name": "TEJASWITA",
        "middle_name": "LAXMAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-05",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME153127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TEJASWITA",
            "last_name": "FULZELE",
            "middle_name": "LAXMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.