Penchala Swamy Mittadodla, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

E-8192 Issued in AR

Practice address

2708 S Rife Medical LN
Ste 200
Rogers, AR 72758-1452

Phone

(479) 338-3080

Fax

(479) 338-3089

NPI assigned

Jul 30, 2009

Last updated

Aug 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Pulmonary Disease

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Health Northwest Arkansas CommunitiesGroup PAC ID 0648177873, 314 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010
• Mercy Hospital Berryville Hospital, Berryville, AR, CCN 041329

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pmittadodla704786@directc.mercy.net

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.

• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  Medicare reassignment Care Compare group NPD
• Mercy Hospital Berryville

  • Critical Access Hospital
  • Berryville, AR
  • NPI 1457306326
  Medicare reassignment NPD
• Mercy Health Northwest Arkansas Communities

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Rogers, AR
  • NPI 1619219474
  NPD
• Mercy Health Northwest Arkansas Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Rogers, AR
  • NPI 1770087371
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Berryville

  • Critical Access Hospital
  • Berryville, AR
  • NPI 1457306326
  Care Compare affiliation
• Mercy Hospital Rogers

  dba Mercy Hospital Northwest Arkansas

  • General Acute Care Hospital
  • Rogers, AR
  • NPI 1316902414
  Care Compare affiliation

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1720219397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 S RIFE MEDICAL LN",
            "address_2": "STE 200",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3080",
            "fax_number": "479-338-3089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 S RIFE MEDICAL LN",
            "address_2": "STE 200",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3080",
            "fax_number": "479-338-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTADODLA",
        "first_name": "PENCHALA",
        "middle_name": "SWAMY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "AR",
            "license": "E-8192",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AR",
            "license": "E-8192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin N Misenheimer, LMSW
• Benjamin Cole Mitchel, MHPP
• Hayley Mitchell, D.C.
• Lauren Elizabeth Mitchell, CF-SLP
• Mackenzie Emily Mitchell, PT, DPT
• Whitney E Mix, LPC
• Andrew Mize, PHARM.D.
• MJ Eldercare Holding Company, LLC (Home Instead)
• Mobilecare
• Kyle Mock, M.D.

• Pulmonary Disease Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Pulmonary Disease Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.