Prathyusha Kethi Reddy, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

L8095 Issued in TX

Practice address

14131 Midway Rd
Suite 620
Addison, TX 75001-3623

Phone

(972) 249-0200

Fax

(972) 249-0206

NPI assigned

Apr 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Prathyusha Kethireddy Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1851358477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14131 MIDWAY RD",
            "address_2": "SUITE 620",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013623",
            "telephone_number": "972-249-0200",
            "fax_number": "972-249-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14131 MIDWAY RD",
            "address_2": "SUITE 620",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013623",
            "telephone_number": "972-249-0200",
            "fax_number": "972-249-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "PRATHYUSHA",
        "middle_name": "KETHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L8095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164235701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164235702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRATHYUSHA",
            "last_name": "KETHIREDDY",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elena Rebholz, DPT
• Stephanie Recendiz
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• Red Maple Holdings, Inc
• Red River Neurodiagnostics, LLC
• Rathidevi Reddy, M.D.
• Tyler Tymel Reed, PTA
• Kennedy Reeder
• Bailey Reeves
• Aaron Reifschneider, CNIM

• Internal Medicine Physician in Addison, TX
• Providers in Addison, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.

Verify at the official NPI Registry.