NPIMap

Organization Active NPI

Mesquite Professional Anesthesia, PA

  • Anesthesiology Physician
  • Mesquite, TX
National Provider Identifier
1831209949
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MESQUITE PROFESSIONAL ANESTHESIA, PA
Practice address
3865 Childress Ave
Mesquite, TX 75150-2802
Phone
(972) 681-7246
NPI assigned
Aug 30, 2006
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
Dr. Nagaraj S Kikkeri, MDNPI 1396745311
Title
Owner
Phone
(972) 681-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

3865 Childress Ave
Mesquite, TX 75150-2802

Mailing address

PO Box 870638
Mesquite, TX 75187-0638
Phone (972) 681-7246

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610000058 TX Part B Supplier - Clinic/Group Practice 0749263812 Receives reassigned benefits from 43 practitioners
Practice locations: Mesquite, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 73

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.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1831209949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870638",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751870638",
            "telephone_number": "972-681-7246",
            "fax_number": "972-681-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 CHILDRESS AVE",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502802",
            "telephone_number": "972-681-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESQUITE PROFESSIONAL ANESTHESIA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "KIKKERI",
        "authorized_official_first_name": "NAGARAJ",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-681-7246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.