NPIMap

Individual provider Active NPI

Srinivasa Reddy Punyala, MBBS

  • Psychiatry Physician
  • Hopewell, VA
National Provider Identifier
1891134599
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
0101262419 Issued in VA
Practice address
207 N 4TH Ave
Hopewell, VA 23860-2503
Phone
(804) 541-0918
Fax
(804) 541-7924
NPI assigned
Jun 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X VA
Psychiatry Physician 2084P0800X 0101262419 VA Primary

Addresses

Primary practice location

207 N 4TH Ave
Hopewell, VA 23860-2503

Mailing address

207 North 4TH Ave.
Hopewell, VA 23860
Phone (804) 541-0918

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170728003278 VA Practitioner - Psychiatry 1052553690 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Virginia South Psychiatric and Family ServicesGroup PAC ID 3476443797, 35 clinicians

Practice addresses (Care Compare)

207 N 4TH Ave
Hopewell, VA 23860-2503
Phone (804) 518-6513

Hospital & facility affiliations

  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
  • John Randolph Medical Center Hospital, Hopewell, VA, CCN 490020
  • Bon Secours Southern Virginia Medical Center Hospital, Emporia, VA, CCN 490097
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136
  • Riverside Doctors' Hospital of Williamsburg Hospital, Williamsburg, VA, CCN 490143

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101262419VAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia South Psychiatric & Family Services Psychiatry CurrentSince Jun 15, 2017 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 14, 2020 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC Psychiatry CurrentSince Jan 14, 2020 Accepting new patients
Three Rivers Treatment Center LLC Past Accepting new patients

Locations

207 N 4th Ave
Hopewell, VA 23860
Phone (804) 518-6513

269 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 861-0700

40 Medical Park Blvd
Ste B
Petersburg, VA 23805
Phone (804) 520-6730

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72142

Organizations & group practices 4

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891134599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 NORTH 4TH AVE.",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "23860",
            "telephone_number": "804-541-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N 4TH AVE",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238602503",
            "telephone_number": "804-541-0918",
            "fax_number": "804-541-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNYALA",
        "first_name": "SRINIVASA",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101262419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hopewell, VA

Sources for this page

Verify at the official NPI Registry.