Tejaswi Venkata Mudigonda, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

73704 Issued in AZ

Practice address

1801 Mesquite Ave
Lake Havasu City, AZ 86403-5668

Phone

(928) 854-5400

Fax

(928) 216-4165

NPI assigned

May 26, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, OR, TN3 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 3

Specialty

Dermatology

Education

Vanderbilt University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Diagnostic Imaging PCGroup PAC ID 7315848140, 523 clinicians

Davishire Dermatology LLCGroup PAC ID 2860870979, 7 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

85.34 of 100Reported as group

Quality

90.85

Promoting interoperability

87

Improvement activities

40

Cost

71.11

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IEAEDD
• FHIR API: https://fhir4.healow.com/fhir/r4/IEAEDD/Endpoint/IEAEDD

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.

• Advanced Diagnostic Imaging, PC

  dba AdvancedHealth

  • Internal Medicine Physician
  • Goodlettsville, TN
  • NPI 1093741464

  Dermatology

  Medicare reassignment Care Compare group NPD
• Davishire Dermatology LLC

  dba Davishire Dermatology

  • Dermatology Physician
  • Nashville, TN
  • NPI 1811648066
  Medicare reassignment Care Compare group NPD
• Integrated Skin Institute PLLC

  • Dermatology Physician
  • Lebanon, TN
  • NPI 1770351041
  Medicare reassignment NPD Authorized official
• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804

  Dermatology

  Medicare reassignment NPD
• Clear Choice Dermatology

  dba The Skin Docs

  • Dermatology Physician
  • The Dalles, OR
  • NPI 1891327185
  Medicare reassignment
• Advanced Diagnostic Imaging PC

  dba Ankle and Foot Centers of Nashville

  • Durable Medical Equipment & Medical Supplies
  • Lewisburg, TN
  • NPI 1922846559
  NPD
• Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1922279496
  NPD
• Douglas a. Thomas, MD

  dba Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1891897658
  NPD (past)

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1891143277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9097 W POST RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482417",
            "telephone_number": "928-854-5400",
            "fax_number": "928-216-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035668",
            "telephone_number": "928-854-5400",
            "fax_number": "928-216-4165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1630 Nashville Pike Ste 200",
            "address_purpose": "LOCATION",
            "city": "Gallatin",
            "state": "TN",
            "postal_code": "370665266",
            "country_code": "US",
            "telephone_number": "615-675-0444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "147 Uptown Sq",
            "address_purpose": "LOCATION",
            "city": "Murfreesboro",
            "state": "TN",
            "postal_code": "371290571",
            "country_code": "US",
            "telephone_number": "615-314-1699",
            "fax_number": "615-622-8905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1424 W Baddour Pkwy Ste G",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "TN",
            "postal_code": "370872685",
            "country_code": "US",
            "telephone_number": "615-314-1699",
            "fax_number": "615-622-8905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10101 Ramsey Way",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Dickson",
            "state": "TN",
            "postal_code": "37055",
            "country_code": "US",
            "telephone_number": "615-314-1699",
            "fax_number": "615-622-8905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 Patterson St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372032165",
            "country_code": "US",
            "telephone_number": "615-314-1699",
            "fax_number": "615-622-8905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "491 Sage Rd N Ste 300",
            "address_purpose": "LOCATION",
            "city": "White House",
            "state": "TN",
            "postal_code": "371889361",
            "country_code": "US",
            "telephone_number": "615-675-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUDIGONDA",
        "first_name": "TEJASWI",
        "middle_name": "VENKATA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-26",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "68967",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TN",
            "license": "68967",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TN",
            "license": "68967",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TN",
            "license": "68967",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "73704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207R00000X",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Mortola, DNP CRNA
• Dee Dennis Moshos Sr., D.D.S.
• Stevie Jean Mueller, FNP-BC
• Ashley Marie Mulder, MD
• Margaret 'Ann' Murray, NMD
• Vivek B Narasimhan, M.D
• Nationwide Optometry P.C. (Nationwide Vision)

• MOHS-Micrographic Surgery Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• MOHS-Micrographic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.