Active NPI
Arjun Ponduri, MD
- Adolescent Medicine (Internal Medicine) Physician
- Las Vegas, NV
National Provider Identifier
1841976370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adolescent Medicine (Internal Medicine) Physician
- License
- LL4063
- Practice address
- 620 Shadow LN
Las Vegas, NV 89106-4119 - Phone
- (702) 388-4000
- NPI assigned
- Jun 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent Medicine (Internal Medicine) Physician | 207RA0000X | LL4063 | NV | Primary |
Addresses
Primary practice location
620 Shadow LN
Las Vegas, NV 89106-4119
Mailing address
8791 Alta Dr Ste 4041
Las Vegas, NV 89145-8578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231010000825 | NV | Order and Referring Only - Internal Medicine | 9032564117 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL4063 | NV | MD | Adolescent Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1841976370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8791 ALTA DR STE 4041",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891458578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 SHADOW LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891064119",
"telephone_number": "702-388-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONDURI",
"first_name": "ARJUN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-27",
"last_updated": "2023-06-27",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RA0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Adolescent Medicine",
"state": "NV",
"license": "LL4063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.