NPIMap

Individual provider Active NPI

Jayachandra Babu Vavilathota, M.D

  • Student in an Organized Health Care Education/Training Program
  • Waterloo, IA
National Provider Identifier
1942455746
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
146 W Dale St
Suite 201
Waterloo, IA 50703-1901
Phone
(319) 234-4431
Fax
(319) 235-5004
NPI assigned
Nov 20, 2008
Last updated
Sep 28, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

146 W Dale St
Suite 201
Waterloo, IA 50703-1901

Mailing address

PO Box 1455
Des Moines, IA 50306-1455
Phone (515) 471-9243

Other identifiers 2

IdentifierTypeStateIssuer
P00741043OtherIARR MEDICARE
1942455746MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150805006522 PA Practitioner - Internal Medicine 2466502521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Mellon Way
Latrobe, PA 15650-1197

100 Excela Health Dr
Latrobe, PA 15650-1197

508 S Church St
Mount Pleasant, PA 15666-1702

508 S Church St (Frick Hospital Ca
Excela Health Obstetrics and Gynecology
Mount Pleasant, PA 15666-1702
Phone (724) 539-8581

532 W Pittsburgh St
Greensburg, PA 15601-2239

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince Aug 1, 2015 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Aug 1, 2015 Accepting new patients
Excela Health Physician Practices, Inc Current Accepting new patients
Westmoreland Regional Hospital Past Accepting new patients

Locations

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

Interoperability endpoints

  • Direct secure messaging: jvavilathota@direct.excelahealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254096000000",
    "number": "1942455746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1455",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503061455",
            "telephone_number": "515-471-9243",
            "fax_number": "515-471-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "SUITE 201",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-234-4431",
            "fax_number": "319-235-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAVILATHOTA",
        "first_name": "JAYACHANDRA BABU",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-20",
        "last_updated": "2009-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00741043",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942455746",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.