Individual provider Active NPI

Supriya Rao Donthamsetty, D.O

  • Anatomic Pathology & Clinical Pathology Physician
  • Houma, LA
National Provider Identifier
1922252576
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
DO.000314 Issued in LA
Practice address
1990 Industrial Blvd
Houma, LA 70363-7055
Phone
(985) 868-9300
Fax
(985) 851-0053
NPI assigned
Nov 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X DO000314 LA
General Practice Physician 208D00000X 1303 SC
General Practice Physician 208D00000X 061418 GA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X DO.000314 LA Primary

Addresses

Primary practice location

1990 Industrial Blvd
Houma, LA 70363-7055

Mailing address

1430 Tulane Ave
# 8679
New Orleans, LA 70112-2632
Phone (504) 988-5224

Other identifiers 1

IdentifierTypeStateIssuer
2300253MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20170210000722 LA Practitioner - Pathology 5799068045 Reassigns benefits to 3 organizations
I20210412000059 MS Practitioner - Pathology 5799068045 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO.000314LAMDAnatomic Pathology & Clinical Pathology Physician
DO000314LAMDAnatomic Pathology & Clinical Pathology Physician
061418GAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Mississippi, LLC CurrentSince Jan 6, 2021 Accepting new patients
Ochsner Mississippi, LLC CurrentSince Jan 6, 2021 Accepting new patients
Ochsner Clinic LLC General Practice Current Accepting new patients
Ochsner Clinic LLC General Practice CurrentSince Jan 24, 2020 Accepting new patients
Ochsner Clinic LLC CurrentSince Jan 24, 2020 Accepting new patients
University Medical Center Management Corporation CurrentSince Mar 1, 2020 Accepting new patients
University Medical Center Management Corporation CurrentSince Mar 1, 2020 Accepting new patients
Administrators of the Tulane Educational Fund CurrentSince Oct 1, 2019 Accepting new patients
Ochsner Mississippi, LLC Current Accepting new patients
Administrators of the Tulane Educational Fund CurrentSince Oct 1, 2019 Accepting new patients

Locations

17000 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 752-2470

1990 Industrial Blvd
Houma, LA 70363
Phone (985) 868-9300

180 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-8284

1430 Tulane Ave
#8679
New Orleans, LA 70112
Phone (504) 988-2436

1415 Tulane Ave
New Orleans, LA 70112
Phone (504) 588-2300

2000 Canal St
New Orleans, LA 70112
Phone (504) 702-2287

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

149 Drinkwater Rd
Bay St Louis, MS 39520
Phone (228) 467-8600

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1922252576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 TULANE AVE",
            "address_2": "# 8679",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122632",
            "telephone_number": "504-988-5224",
            "fax_number": "504-988-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONTHAMSETTY",
        "first_name": "SUPRIYA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-10",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "DO000314",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "1303",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "061418",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "DO.000314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2300253",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

Verify at the official NPI Registry.