Active NPI
Mudalodu Veeraraghavachar Vasudevan, MD
- Family Medicine Physician
- Las Vegas, NV
National Provider Identifier
1912240698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 17489
- Practice address
- 2470 E Flamingo Rd Ste D
Las Vegas, NV 89121-5200 - Phone
- (702) 544-3849
- NPI assigned
- Apr 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301102270 | MI | |
| Family Medicine Physician | 207Q00000X | 17489 | NV | Primary |
Addresses
Primary practice location
2470 E Flamingo Rd Ste D
Las Vegas, NV 89121-5200
Mailing address
164 W Invitar LN
MTN House, CA 95391-2036
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5315058571 | Other | MI | PHARMACY LICENSE CONTROLLED SUBSTANCE NUMBER |
| 4301102270 | Other | MI | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17489 | NV | MD | Pharmacist |
| 4301102270 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510963200000",
"number": "1912240698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 W INVITAR LN",
"city": "MTN HOUSE",
"state": "CA",
"postal_code": "953912036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2470 E FLAMINGO RD STE D",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891215200",
"telephone_number": "702-544-3849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASUDEVAN",
"first_name": "MUDALODU",
"middle_name": "VEERARAGHAVACHAR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-01",
"last_updated": "2017-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301102270",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NV",
"license": "17489",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE CONTROLLED SUBSTANCE NUMBER",
"identifier": "5315058571",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "4301102270",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.