Pinnamaneni Prasad, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036049086 Issued in IL

Practice address

2901 Old Jacksonville Rd
Springfield, IL 62704-7437

Phone

(217) 698-9722

Fax

(217) 391-0392

NPI assigned

Aug 9, 2006

Last updated

Jan 3, 2022By 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 1

Addresses

Other identifiers 12

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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

• Physicians Group Associates S C

  • Internal Medicine Physician
  • Springfield, IL
  • NPI 1689606246
  NPD (past)
• Physicians Group Associates S C

  • Nurse Practitioner
  • Springfield, IL
  • NPI 1841216975
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1730199829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "CHATHAM",
            "state": "IL",
            "postal_code": "626290500",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 OLD JACKSONVILLE RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047437",
            "telephone_number": "217-698-9722",
            "fax_number": "217-391-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRASAD",
        "first_name": "PINNAMANENI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036049086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "053701",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CATERPILLAR",
            "identifier": "6394P",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "102120",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "110140986",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE",
            "identifier": "036049086",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036049086",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "08421024",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "020057300",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS-OWCP",
            "identifier": "133586700",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0949277",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CARE",
            "identifier": "170775",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP#",
            "identifier": "CD7143",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pprasad31845@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2901 Old Jacksonville Rd",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627047437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Prairie Podiatry L.L.C.
• Prairie Psychotherapy Associates, PC
• Prairie Sleep Center LLC
• Prairie Sleep Center LLC
• Vidhya Prakash, M.D.
• Sidarrth Prasad, MBBS
• Sudha G Prasad, M.D.C.S.
• Christina Prefountain, RNFA
• Premier Vision Center LLC
• Premiere Physical Therapy & Sport Rehabilitation

• Internal Medicine Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.