Prabhavathi Gummalla, M.D

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

MD458931 Issued in PA

Practice address

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Phone

(917) 715-5360

NPI assigned

Apr 16, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, PA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Childrens Health Care Associates, Inc

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1598869059

  Multi-Specialty

  Medicare reassignment NPD
• Childrens Health Care Associates of New Jersey PC

  • Pediatrics Physician
  • Voorhees, NJ
  • NPI 1427152917

  Multi-Specialty

  Medicare reassignment NPD
• Valley Physician Services PC

  • Internal Medicine Physician
  • Paramus, NJ
  • NPI 1467815928

  Multi-Specialty

  Medicare reassignment NPD
• Childen'S Health Care Associates Inc.

  • Pediatric Registered Nurse
  • Philadelphia, PA
  • NPI 1699860643

  Multi-Specialty

  NPD
• Childrens Health Care Associates, Inc

  • Pediatric Pulmonology Physician
  • Philadelphia, PA
  • NPI 1760577712

  Multi-Specialty

  NPD
• Childens Health Care Associates of New Jersey PC

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Voorhees, NJ
  • NPI 1467547471
  NPD
• Children'S Healthcare Associates of New Jersey PC

  • Pediatric Pulmonology Physician
  • Voorhees, NJ
  • NPI 1578658597
  NPD

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1750700852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2-10 LINDEN AVE",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332556",
            "telephone_number": "917-715-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "917-715-5360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Bowman Dr",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080439623",
            "country_code": "US",
            "telephone_number": "215-590-7490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUMMALLA",
        "first_name": "PRABHAVATHI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NJ",
            "license": "25MA10793600",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NY",
            "license": "285065",
            "primary": false
        },
        {
            "code": "2080S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Sleep Medicine",
            "state": "PA",
            "license": "MD458931",
            "primary": false
        },
        {
            "code": "2080S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Sleep Medicine",
            "state": "NJ",
            "license": "25MA10793600",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "PA",
            "license": "MD458931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jereda Gullatt
• Tamica Marie Gullins, BACHELOR OF SCIENCE
• Mary Gulotta
• Andrew Alexander Gumbs, M.D
• Misshasha Magriet Gumbs
• Kritika Gunachelvan, MD
• Maduka Gunasinghe, DO
• Naomi Gunawardena
• Meredith Alane Gunder, MD
• Ryan Gunderman, FNP

• Pediatric Pulmonology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Pulmonology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.