Active NPI
Jagan Annabathula, MD
- Internal Medicine Physician
- Grethel, KY
National Provider Identifier
1922090190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 33239
- Practice address
- 7629 Ky Route 979
Grethel, KY 41631-6304 - Phone
- (606) 587-2200
- Fax
- (606) 587-2203
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 33239 | KY | Primary |
Addresses
Primary practice location
7629 Ky Route 979
Grethel, KY 41631-6304
Mailing address
1709 Ky Route 321
Ste 3
Prestonsburg, KY 41653-9101
Phone (606) 886-8546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64018427 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140612001517 | KY | Order and Referring Only - Internal Medicine | 0749210821 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Sandy Health Care Inc | Past | Accepting new patients | |
| United Emergency Services, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Paintsville, KY
- NPI 1326729773
-
- Emergency Medicine Physician
- Booneville, MS
- NPI 1326007915
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1922090190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1709 KY ROUTE 321",
"address_2": "STE 3",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "416539101",
"telephone_number": "606-886-8546",
"fax_number": "606-886-8548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7629 KY ROUTE 979",
"city": "GRETHEL",
"state": "KY",
"postal_code": "416316304",
"telephone_number": "606-587-2200",
"fax_number": "606-587-2203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANNABATHULA",
"first_name": "JAGAN",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-16",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KY",
"license": "33239",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64018427",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grethel, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.