Active NPI
Trivikram Reddy
- Family Nurse Practitioner
- Corsicana, TX
National Provider Identifier
1700154010
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Oct 20, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP121198
- Practice address
- 3201 W Highway 22
Corsicana, TX 75110-2450 - Phone
- (469) 773-4242
- NPI assigned
- Dec 1, 2011
- Reactivated
- Apr 17, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP121198 | TX | Primary |
Addresses
Primary practice location
3201 W Highway 22
Corsicana, TX 75110-2450
Mailing address
3201 W Highway 22
Corsicana, TX 75110-2450
Phone (469) 773-4242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP121198 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555459200000",
"number": "1700154010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 W HIGHWAY 22",
"city": "CORSICANA",
"state": "TX",
"postal_code": "751102450",
"telephone_number": "469-773-4242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 W HIGHWAY 22",
"city": "CORSICANA",
"state": "TX",
"postal_code": "751102450",
"telephone_number": "469-773-4242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDY",
"first_name": "TRIVIKRAM",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-01",
"last_updated": "2019-04-17",
"deactivation_date": "2019-04-11",
"reactivation_date": "2019-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP121198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corsicana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.