Individual provider Active NPI

Deepika Reddy Nallala, M.D

  • Endocrinology, Diabetes & Metabolism Physician
  • Johnson City, TN
National Provider Identifier
1851609739
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
54984 Issued in TN
Practice address
325 N State of Franklin Rd FL 2
Johnson City, TN 37604-6092
Phone
(423) 439-7280
NPI assigned
Sep 14, 2010
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X MD468743 PA
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 036127090 IL
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 54984 TN Primary

Addresses

Primary practice location

325 N State of Franklin Rd FL 2
Johnson City, TN 37604-6092

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 302-6882

Other practice location 1

4 Sheridan Sq Ste 200
Kingsport, TN 37660-7435
Phone (423) 246-7931

Other identifiers 2

IdentifierTypeStateIssuer
3714470OtherTNGRP MEDICARE
Q025639MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170105001396 TN Practitioner - Endocrinology 3971740572 Reassigns benefits to 1 organization
I20191101000080 PA Practitioner - Endocrinology 3971740572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

325 N State of Franklin Rd
FL 2
Johnson City, TN 37604-6092
Phone (423) 439-7280

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD468743PAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation Endocrinology, Diabetes & Metabolism CurrentSince Nov 18, 2016 Accepting new patients
Tower Health Medical Group CurrentSince Sep 16, 2019 Accepting new patients
Tower Health Medical Group Current Accepting new patients
Tower Health Medical Group CurrentSince Sep 16, 2019 Accepting new patients
Medical Education Assistance Corporation Past Accepting new patients
Medical Education Assistance Corporation Endocrinology, Diabetes & Metabolism PastSince Nov 18, 2016 Accepting new patients

Locations

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

1991 State Hill Rd
Wyomissing, PA 19610
Phone (484) 628-4270

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

325 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 439-7280

325 N State of Franklin Rd
Fl 2
Johnson City, TN 37604
Phone (423) 439-7280

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

4 Sheridan Sq
Ste 200
Kingsport, TN 37660
Phone (423) 246-7931

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1851609739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-302-6882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD FL 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046092",
            "telephone_number": "423-439-7280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Sheridan Sq Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376607435",
            "country_code": "US",
            "telephone_number": "423-246-7931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NALLALA",
        "first_name": "DEEPIKA REDDY",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-14",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "PA",
            "license": "MD468743",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "036127090",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TN",
            "license": "54984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP MEDICARE",
            "identifier": "3714470",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q025639",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.