NPIMap

Individual provider Active NPI

Banu Prasad Myneni, D.O.

  • Family Medicine Physician
  • Portsmouth, VA
National Provider Identifier
1780082693
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102206019 Issued in VA
Practice address
3235 Academy Ave Ste 101
Portsmouth, VA 23703-3200
Phone
(757) 484-7386
NPI assigned
Dec 9, 2014
Last updated
May 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-144866 IL
Family Medicine Physician 207Q00000X 0102206019 VA Primary

Addresses

Primary practice location

3235 Academy Ave Ste 101
Portsmouth, VA 23703-3200

Mailing address

3235 Academy Ave Ste 101
Portsmouth, VA 23703-3200
Phone (757) 484-7386

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200622002607 VA Practitioner - Family Practice 3274893623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

3235 Academy Ave
Suite 101
Portsmouth, VA 23703-3200
Phone (757) 484-7386

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-144866ILMDFamily Medicine Physician
0102206019VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Family Medicine CurrentSince May 19, 2020 Accepting new patients
Privia Medical Group, LLC CurrentSince May 19, 2020 Accepting new patients
Nova Physician Wellness Center PLLC Family Medicine Past Accepting new patients

Locations

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

8644 Sudley Rd
#220
Manassas, VA 20110

3235 Academy Ave
Ste 101
Portsmouth, VA 23703
Phone (757) 484-7386

Interoperability endpoints

  • Direct secure messaging: banu.myneni.1@8042.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1780082693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE STE 101",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-484-7386",
            "fax_number": "757-484-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE STE 101",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-484-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYNENI",
        "first_name": "BANU",
        "middle_name": "PRASAD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-09",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-144866",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102206019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.