Individual provider Active NPI

Vidya Surapaneni, M.D

  • Pediatrics Physician
  • Phoenix, AZ
National Provider Identifier
1851521785
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
46178 Issued in AZ
Practice address
2510 W Dunlap Ave
Suite 290
Phoenix, AZ 85021-2737
Phone
(602) 789-0344
Fax
(602) 789-8389
NPI assigned
Jul 27, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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 46178 AZ Primary

Addresses

Primary practice location

2510 W Dunlap Ave
Suite 290
Phoenix, AZ 85021-2737

Mailing address

2510 W Dunlap Ave
Suite 290
Phoenix, AZ 85021-2737
Phone (602) 789-0344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20161108002644 AZ Practitioner - Pediatric MedicinePractitioner - Hospitalist 9931488210 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Super Specialists Arizona LLC Current Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Jan 1, 2018 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Apr 21, 2020 Accepting new patients
Banner-University Medical Group CurrentSince Dec 1, 2024 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Jan 1, 2018 Accepting new patients
Banner-University Medical Group Family Medicine Current Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Arizona Acute Medical Services 1 PC CurrentSince Apr 1, 2017 Accepting new patients
Banner-University Medical Group CurrentSince Dec 1, 2024 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Apr 21, 2020 Accepting new patients
Arizona Post-Acute Medical Services 1 PC Past Accepting new patients
Banner Desert Medical Center Past Accepting new patients
Banner del E Webb Medical Center Past Accepting new patients
Banner Gateway Medical Center Past Accepting new patients

Locations

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

3929 E Bell Rd
Phoenix, AZ 85032
Phone (602) 923-5000

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

2510 W Dunlap Ave
Ste 290
Phoenix, AZ 85021

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

14502 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 214-4000

1921 W Hospital Dr
Tucson, AZ 85704
Phone (520) 544-5200

1625 N Campbell Ave
Tucson, AZ 85719

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415145600000",
    "number": "1851521785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 W DUNLAP AVE",
            "address_2": "SUITE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212737",
            "telephone_number": "602-789-0344",
            "fax_number": "602-789-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 W DUNLAP AVE",
            "address_2": "SUITE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212737",
            "telephone_number": "602-789-0344",
            "fax_number": "602-789-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURAPANENI",
        "first_name": "VIDYA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-27",
        "last_updated": "2014-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "46178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.