Individual provider Active NPI

Lakshmi N Koonapu, M.D

  • Pediatrics Physician
  • Fort Campbell, KY
National Provider Identifier
1841266632
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L8144 Issued in TX
Practice address
Blanchfield Army Community Hospital
650 Joel Dr
Fort Campbell, KY 42223-5349
Phone
(832) 283-4580
NPI assigned
Feb 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X L8144 TX Primary

Addresses

Primary practice location

Blanchfield Army Community Hospital
650 Joel Dr
Fort Campbell, KY 42223-5349

Mailing address

Blanchfield Army Community Hospital
650 Joel Dr
Fort Campbell, KY 42223-5349
Phone (832) 283-4580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150904001611 GA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 0345556387 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L8144TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Workit Health Mi PLLC CurrentSince Mar 9, 2022 Accepting new patients
The Bortolazzo Group, LLC CurrentSince Aug 1, 2015 Accepting new patients
Workit Health Mi PLLC CurrentSince Mar 9, 2022 Accepting new patients

Locations

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1841266632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
            "address_2": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235349",
            "telephone_number": "832-283-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
            "address_2": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235349",
            "telephone_number": "832-283-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONAPU",
        "first_name": "LAKSHMI",
        "middle_name": "N",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L8144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

Verify at the official NPI Registry.