Active NPI
Suresh Kumar Donepudi, MD
- Psychiatry Physician
- Shreveport, LA
National Provider Identifier
1922075035
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Oct 20, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 017479
- Practice address
- 8921 Mansfield Rd
Shreveport, LA 71118-2144 - Phone
- (318) 688-5416
- Fax
- (318) 688-5823
- NPI assigned
- Mar 7, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 017479 | LA | Primary |
Addresses
Primary practice location
8921 Mansfield Rd
Shreveport, LA 71118-2144
Mailing address
8921 Mansfield Rd
Shreveport, LA 71118-2144
Phone (318) 688-5416
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1380181 | Medicaid | LA |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017479 | LA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922075035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8921 MANSFIELD RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711182144",
"telephone_number": "318-688-5416",
"fax_number": "318-688-5823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8921 MANSFIELD RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711182144",
"telephone_number": "318-688-5416",
"fax_number": "318-688-5823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONEPUDI",
"first_name": "SURESH",
"middle_name": "KUMAR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "LA",
"license": "017479",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1380181",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.