Active NPI
Vidur Siddhanth Mahadeva, M.D.
- Internal Medicine Physician
- Fallon, NV
National Provider Identifier
1760451769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 11257
- Practice address
- 801 E Williams Ave
Fallon, NV 89406-3052 - Phone
- (775) 423-3151
- Fax
- (775) 423-2853
- NPI assigned
- Mar 14, 2006
- Last updated
- Nov 30, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 11257 | NV | Primary |
Addresses
Primary practice location
801 E Williams Ave
Fallon, NV 89406-3052
Mailing address
1441 N 12TH St
Phoenix, AZ 85006-2837
Phone (602) 495-4577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100508290 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160212002227 | NV | Order and Referring Only - Internal Medicine | 5496708901 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Usacs Integrated Acute Care Services of Nevada Bagnoli P C | Past | Accepting new patients | |
| Go Assisted, Inc. | Past | Accepting new patients | |
| Vista Hospice Care, LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Lake Tahoe Regional Hospitalists
- Hospitalist Physician
- Carson City, NV
- NPI 1063608701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354233600000",
"number": "1760451769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1441 N 12TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062837",
"telephone_number": "602-495-4577",
"fax_number": "602-417-3549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 E WILLIAMS AVE",
"city": "FALLON",
"state": "NV",
"postal_code": "894063052",
"telephone_number": "775-423-3151",
"fax_number": "775-423-2853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHADEVA",
"first_name": "VIDUR",
"middle_name": "SIDDHANTH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2012-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NV",
"license": "11257",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100508290",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fallon, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; 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.