Active NPI
Sadeka Tamanna, M.D.
- Internal Medicine Physician
- Jackson, MS
National Provider Identifier
1740264035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20279
- Practice address
- 1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116 - Phone
- (601) 362-4471
- NPI assigned
- Dec 1, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 46125 | MN | |
| Internal Medicine Physician | 207R00000X | 20279 | MS | Primary |
Addresses
Primary practice location
1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116
Mailing address
1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116
Phone (601) 362-4471
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP39742 | Other | FM | HEALTH PARTNERS |
| 04-06054 | Other | MN | MEDICA |
| 131014 | Medicaid | MN | |
| 565333 | Medicaid | IA | |
| 06325569 | Medicaid | MS | |
| 155L1TA | Other | MN | BCBS |
| 1907895 | Other | MN | ARAZ |
| 155L1TA | Other | MN | BLUE PLUS |
| 8586 | Other | MN | AVERA |
| 916487100 | Medicaid | MN | |
| 155L1TA | Other | MN | BCBS/MEDICARE SUPPLEMENT |
| MH9041035331 | Other | MN | PPO |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20279 | MS | MD | Internal Medicine Physician |
| 100893 | MN | MD | Occupational Therapist |
Interoperability endpoints
- sadeka.tamanna.1@20428.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399593600000",
"number": "1740264035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAMANNA",
"first_name": "SADEKA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-01",
"last_updated": "2014-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "46125",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "20279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP39742",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "04-06054",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131014",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "565333",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06325569",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "155L1TA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "1907895",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE PLUS",
"identifier": "155L1TA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVERA",
"identifier": "8586",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "916487100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS/MEDICARE SUPPLEMENT",
"identifier": "155L1TA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PPO",
"identifier": "MH9041035331",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.