Phani Bodavula, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

R5085 Issued in TX

Practice address

6448 Broadway Blvd
Garland, TX 75043

Phone

(972) 216-8500

Fax

(972) 216-8521

NPI assigned

Mar 28, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

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

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

• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Pediatrics

  Medicare reassignment NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD
• Bodavula Pediatrics PLLC

  • Pediatrics Physician
  • Garland, TX
  • NPI 1366008294
  NPD Authorized official

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758326400000",
    "number": "1700204690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6448 BROADWAY BLVD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750435943",
            "telephone_number": "972-216-8500",
            "fax_number": "972-216-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6448 BROADWAY BLVD",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75043",
            "telephone_number": "972-216-8500",
            "fax_number": "972-216-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODAVULA",
        "first_name": "PHANI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-28",
        "last_updated": "2025-09-20",
        "certification_date": "2025-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R5085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CONNECT",
            "affiliation": "N",
            "address_1": "6448 Broadway Blvd",
            "city": "Garland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "75043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharhonda Blue, PA-C
• Bluehaven Psychiatry PLLC
• Blueprints at Room for Change PLLC
• Carmen Blunt, DDS
• Bodavula Pediatrics PLLC
• Sreevani Bodavula, APRN, FNP-C
• Jillian M Boehm, PA-C
• Felicia Boggess
• Houston Bogus Jr., M.D.
• Dana Boles, ACP

• Pediatrics Physician in Garland, TX
• Providers in Garland, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.