Organization Active NPI

Vedampattu P Ganeshram MD PLLC

  • Cardiovascular Disease Physician
  • Wichita Falls, TX
National Provider Identifier
1790227387
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
VEDAMPATTU P GANESHRAM MD PLLC
Practice address
1631 11TH St
Wichita Falls, TX 76301-4322
Phone
(940) 687-5100
NPI assigned
Nov 14, 2016
Last updated
Nov 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Authorized official

Name
Vedampattu P Ganeshram, MD
Title
Owner/Sole Member
Phone
(940) 687-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

1631 11TH St
Wichita Falls, TX 76301-4322

Mailing address

1631 11TH St
Wichita Falls, TX 76301-4322
Phone (940) 687-5100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161219000779 TX Part B Supplier - Clinic/Group Practice 3274813852 Receives reassigned benefits from 1 practitioner
Practice locations: Wichita Falls, TX

National Provider Directory

National Provider Directory

Locations

1631 11th St
Wichita Falls, TX 76301
Phone (940) 687-5000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1479081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1790227387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014322",
            "telephone_number": "940-687-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014322",
            "telephone_number": "940-687-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VEDAMPATTU P GANESHRAM MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-14",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "GANESHRAM",
        "authorized_official_first_name": "VEDAMPATTU",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/SOLE MEMBER",
        "authorized_official_telephone_number": "940-687-5100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.