NPIMap

Individual provider Active NPI

Prashant Pendyala, MD

  • Nephrology Physician
  • Lockport, NY
National Provider Identifier
1801842844
Registry record updated Mar 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
241265 Issued in NY
Practice address
53 Elizabeth Dr
Lockport, NY 14094-5226
Phone
(716) 650-0373
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 001535 NY
Nephrology Physician 207RN0300X 241265 NY Primary

Addresses

Primary practice location

53 Elizabeth Dr
Lockport, NY 14094-5226

Mailing address

50 Sanctuary CT
Buffalo, NY 14221-3963
Phone (716) 912-9595

Other identifiers 1

IdentifierTypeStateIssuer
02212706MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20051103000718 NY Practitioner - Internal MedicinePractitioner - Nephrology 1355369810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney and Hypertension Physician PCGroup PAC ID 6800080649, 4 clinicians

Practice addresses (Care Compare)

53 Elizabeth Dr
Lockport, NY 14094-5226
Phone (716) 650-0373

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001535NYMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: drpendyala@kidneyandhypertension.medentdirect.com

Organizations & group practices 1

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 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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615680000000",
    "number": "1801842844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 SANCTUARY CT",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142213963",
            "telephone_number": "716-912-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 ELIZABETH DR",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945226",
            "telephone_number": "716-650-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDYALA",
        "first_name": "PRASHANT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "001535",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "241265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02212706",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lockport, NY

Sources for this page

Verify at the official NPI Registry.