Praveen Srisatya Nimmagadda, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

107580 Issued in MO

Practice address

5300 Arsenal St
Saint Louis, MO 63139-1463

Phone

(314) 877-5989

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of MissouriGroup PAC ID 1456254226, 48 clinicians

Practice addresses (Care Compare)

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.

• State of Missouri

  • Psychiatry Physician
  • Farmington, MO
  • NPI 1437106705
  Medicare reassignment Care Compare group NPD
• Compass Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1558258632
  NPD (past)
• Compass Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Saint Charles, MO
  • NPI 1083033591
  NPD (past)
• State of Missouri

  • Psychiatric Hospital
  • Farmington, MO
  • NPI 1861447526
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422576000000",
    "number": "1689722951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 ARSENAL ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631391463",
            "telephone_number": "314-877-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 ARSENAL ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631391463",
            "telephone_number": "314-877-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIMMAGADDA",
        "first_name": "PRAVEEN",
        "middle_name": "SRISATYA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2015-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "107580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208484105",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "107580",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Gerard Nikodem, DDS
• Stephen Gerard Nikodem, DDS,.MS
• Stephen Mark Nikodem, DDS
• Jamie Louise Nilson, RD
• Pascal Nilsson, MD
• Shalaka Nimmagadda, MD
• Nina Corporation
• Richa Niraula, M.D.
• Nirvana Healthcare Plus LLC
• Omar Nisar, MD

• Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.