NPIMap

Individual provider Active NPI

Gayathri Talluri, MD

  • Internal Medicine Physician
  • Thibodaux, LA
National Provider Identifier
1699792564
Registry record updated Feb 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
13169R Issued in LA
Practice address
931 North Canal Blvd
Thibodaux, LA 70301
Phone
(985) 446-6381
Fax
(985) 446-5992
NPI assigned
Jul 16, 2006
Last updated
Feb 23, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 13169R LA Primary

Addresses

Primary practice location

931 North Canal Blvd
Thibodaux, LA 70301

Mailing address

931 North Canal Blvd
Thibodaux, LA 70301
Phone (985) 446-6381

Other identifiers 1

IdentifierTypeStateIssuer
1557412MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20100218000852 LA Practitioner - Internal Medicine 9032253752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raja Talluri MD a Professional Medical CorporationGroup PAC ID 6608817077, 4 clinicians
St Joseph Medical Clinic a Medical CorporationGroup PAC ID 9335189109, 3 clinicians

Practice addresses (Care Compare)

931 N Canal Blvd
Thibodaux, LA 70301-8095

PO Box
Suite 69
Vacherie, LA 70090-0069

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13169RLAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Raja Talluri MD a Professional Medical Corporation Internal Medicine CurrentSince Sep 27, 2009 Accepting new patients
Nexion Health at Thibodaux, Inc. Past Accepting new patients
SCC of Houma LLC Past Accepting new patients
Thibodaux Regional Health System Inc Past Accepting new patients

Locations

1214 Cardinal Dr
Thibodaux, LA 70301
Phone (985) 446-6381

931 N Canal Blvd
Thibodaux, LA 70301
Phone (985) 446-6381

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487808000000",
    "number": "1699792564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 NORTH CANAL BLVD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-6381",
            "fax_number": "985-446-5992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 NORTH CANAL BLVD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-6381",
            "fax_number": "985-446-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLURI",
        "first_name": "GAYATHRI",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2017-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "13169R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557412",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

Verify at the official NPI Registry.