Rao Prasad Immaneni, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

044756 Issued in GA

Practice address

1230 Brampton Ave
Statesboro, GA 30458-0849

Phone

(912) 489-5437

Fax

(912) 489-5550

NPI assigned

Aug 29, 2006

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 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• East Georgia Healthcare Center, Inc.

  dba Emanuel County Institute

  • Federally Qualified Health Center (FQHC)
  • Twin City, GA
  • NPI 1568330652
  NPD (past)
• South Georgia Pediatrics, P.C.

  • Specialist
  • Statesboro, GA
  • NPI 1578797627
  NPD (past)

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1720196520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1039",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304591039",
            "telephone_number": "912-489-5437",
            "fax_number": "912-489-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 BRAMPTON AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580849",
            "telephone_number": "912-489-5437",
            "fax_number": "912-489-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMANENI",
        "first_name": "RAO",
        "middle_name": "PRASAD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "044756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE ID",
            "identifier": "000798377A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2263921",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "598970",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN/FIRST HEALTH",
            "identifier": "1917290",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5261615",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007241193",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000798377A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PROVIDER ID",
            "identifier": "10057735",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "336225",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridgette Hutchins
• Liz Hutley, NP
• I V Care of Middle Georgia Inc (I V Care Options)
• Chizoba Ifeorah
• Sajeel Ijaz, M.D.
• Independent Physical Therapy of Ga, LLC
• Infinite Medical Ga LLC
• Infinite Specialty Medical Services Ga LLC
• Innovative Clinical Services LLC
• Internal Medicine Associates of Statesboro II, PC

• Pediatrics Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.