NPIMap

Individual provider Active NPI

Venugopal Botla, MD

  • Nephrology Physician
  • Las Vegas, NV
National Provider Identifier
1689656357
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
11677 Issued in NV
Practice address
1294 S Jones Blvd
Suite 12
Las Vegas, NV 89146
Phone
(702) 877-1887
Fax
(702) 877-4536
NPI assigned
Nov 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 11677 NV Primary

Addresses

Primary practice location

1294 S Jones Blvd
Suite 12
Las Vegas, NV 89146

Mailing address

1294 S Jones Blvd
Suite 12
Las Vegas, NV 89146
Phone (702) 877-1887

Other identifiers 1

IdentifierTypeStateIssuer
100508284MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20060123000859 NV Practitioner - Nephrology 1658333265 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Northwestern University Feinberg Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology and Endocrine Associates IncGroup PAC ID 2961499322, 64 clinicians

Practice addresses (Care Compare)

8775 Deer Springs Way
Las Vegas, NV 89149-0416
Phone (702) 877-1887

Hospital & facility affiliations

  • DaVita Las Vegas Dialysis Center Dialysis facility, Las Vegas, NV, CCN 292501
  • Mountainview Hospital Hospital, Las Vegas, NV, CCN 290039
  • University Medical Center Hospital, Las Vegas, NV, CCN 290007
  • Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290021

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology & Endocrine Associates Inc Nephrology CurrentSince Nov 15, 2005 Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients
Jordan Physician Associates, Inc. Family Medicine Past Accepting new patients

Locations

657 N Town Center Dr
Las Vegas, NV 89144
Phone (702) 233-7571

1294 S Jones Blvd
#12
Las Vegas, NV 89146

1294 S Jones Blvd
Las Vegas, NV 89146
Phone (702) 877-1877

7326 W Cheyenne Ave
Ste 110
Las Vegas, NV 89129
Phone (702) 258-0078

8775 Deer Springs Way
Las Vegas, NV 89149
Phone (702) 395-2488

1294 S Jones Blvd
Ste 12
Las Vegas, NV 89146

500 S Rancho Dr
Ste 12
Las Vegas, NV 89106
Phone (702) 877-1877

3150 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 258-0078

Interoperability endpoints

  • Direct secure messaging: vbotla18585@direct.umcsn.com
  • Direct secure messaging: venugopal.botla.p35@direct.lifelinevascular.nextgenshare.com
  • Direct secure messaging: venugopal.botla@direct.davitaphysiciansolutions.com
  • Direct secure messaging: venugopal.botla.p208@direct.aac.nextgenshare.com

Organizations & group practices 5

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1689656357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 S JONES BLVD",
            "address_2": "SUITE 12",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89146",
            "telephone_number": "702-877-1887",
            "fax_number": "702-877-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 S JONES BLVD",
            "address_2": "SUITE 12",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89146",
            "telephone_number": "702-877-1887",
            "fax_number": "702-877-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTLA",
        "first_name": "VENUGOPAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NV",
            "license": "11677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100508284",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.