Individual provider Active NPI

Siva Prasad Mullangi, M.D.

  • Surgery Physician
  • Springfield, TN
National Provider Identifier
1750592242
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
69619 Issued in TN
Practice address
417 Northcrest Dr
Springfield, TN 37172-3973
Phone
(615) 384-8211
Fax
(615) 384-5859
NPI assigned
May 25, 2007
Last updated
Apr 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 69619 TN Primary

Addresses

Primary practice location

417 Northcrest Dr
Springfield, TN 37172-3973

Mailing address

417 Northcrest Dr
Springfield, TN 37172-3973
Phone (615) 384-8211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20240405003458 TN Practitioner - General Surgery 4688766744

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.64 of 100Reported as group
Quality
74.2
Promoting interoperability
99
Improvement activities
40
Cost
66.56

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69619TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pih Health Physicians CurrentSince Apr 26, 2023 Accepting new patients
Pih Health Physicians Current Accepting new patients
Pih Health Physicians Neurological Surgery CurrentSince Apr 26, 2023 Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Uhs Corona Inc Past Accepting new patients
Pinnacle Medical Group, Inc. Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients

Locations

12675 La Mirada Blvd
Ste 201401
La Mirada, CA 90638
Phone (562) 903-7339

12401 Washington Blvd
Whittier, CA 90602
Phone (562) 698-0611

12462 Putnam St
Whittier, CA 90602
Phone (562) 789-5430

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1750592242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 NORTHCREST DR",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371723973",
            "telephone_number": "615-384-8211",
            "fax_number": "615-384-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 NORTHCREST DR",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371723973",
            "telephone_number": "615-384-8211",
            "fax_number": "615-384-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANGI",
        "first_name": "SIVA",
        "middle_name": "PRASAD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "69619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, TN

Sources for this page

Verify at the official NPI Registry.