NPIMap

Individual provider Active NPI

Chandra Mouli Nukala, M.D

  • Hospitalist Physician
  • Little Rock, AR
National Provider Identifier
1770715591
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
E-8700 Issued in AR
Practice address
2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone
(501) 552-4677
Fax
(501) 552-4555
NPI assigned
Aug 12, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X E-8700 AR Primary
Family Medicine Physician 207Q00000X 27289 OK

Addresses

Primary practice location

2 Saint Vincent Cir
Little Rock, AR 72205-5423

Mailing address

2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone (501) 552-4677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, GA, AR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20131219000265 TX Practitioner - Geriatric Medicine 3476780453 Reassigns benefits to 1 organization
I20170918000973 GA Practitioner - Family Practice 3476780453 Reassigns benefits to 1 organization
I20200804002058 AR Practitioner - HospitalistPractitioner - Family Practice 3476780453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical GroupGroup PAC ID 5698758803, 237 clinicians

Practice addresses (Care Compare)

2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone (501) 552-4666

Hospital & facility affiliations

  • CHI-St Vincent Infirmary Hospital, Little Rock, AR, CCN 040007
  • St Vincent Medical Center/North Hospital, Sherwood, AR, CCN 040137
  • White County Medical Center Hospital, Searcy, AR, CCN 040014
  • Dewitt Hospital & Nursing Home, Inc Hospital, De Witt, AR, CCN 040783
  • St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Choctaw Nation of Oklahoma CurrentSince Sep 7, 2013 Accepting new patients
Cogent Healthcare of Georgia PC Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Choctaw Nation of Oklahoma Current Accepting new patients
St. Vincent Medical Group Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Sep 7, 2013 Accepting new patients
St Vincent Physician Clinics LLC Family Medicine Past Accepting new patients

Locations

16221 Saint Vincent Way
Little Rock, AR 72223
Phone (501) 221-0888

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

2215 Wildwood Ave
Sherwood, AR 72120
Phone (501) 522-7100

200 Industrial Blvd
Dublin, GA 31021
Phone (478) 274-3865

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

902 E Lincoln Rd
Idabel, OK 74745
Phone (580) 286-2600

1127 S George Nigh Expy
McAlester, OK 74501
Phone (800) 349-7026

109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100

205 Dallas St
Talihina, OK 74571
Phone (918) 567-3636

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

Organizations & group practices 6

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.

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1770715591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423",
            "telephone_number": "501-552-4677",
            "fax_number": "501-552-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT VINCENT CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055423",
            "telephone_number": "501-552-4677",
            "fax_number": "501-552-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUKALA",
        "first_name": "CHANDRA MOULI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-12",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AR",
            "license": "E-8700",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "27289",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.