Individual provider Active NPI

Priyanka Tadepalli, CPNP-PC

  • Pediatric Nurse Practitioner
  • Middletown, NY
National Provider Identifier
1942812623
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
383161 Issued in NY
Practice address
707 E Main St
Middletown, NY 10940-2650
Phone
(845) 333-3370
Fax
(845) 333-3372
NPI assigned
Aug 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 383161 NY Primary

Addresses

Primary practice location

707 E Main St
Middletown, NY 10940-2650

Mailing address

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-3370

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ptadepalli58727@direct.garnethealth.org Garnet Health Doctors PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221128000163 CT Practitioner - Nurse Practitioner 6305266172 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11121CTMDPhysical Therapist
383161NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Day Kimball Medical Group Inc CurrentSince Nov 2, 2022 Accepting new patients

Locations

132 Westminster Rd
Canterbury, CT 06331
Phone (860) 546-2225

12 Lathrop Rd
Plainfield, CT 06374
Phone (860) 457-9150

320 Pomfret St
Putnam, CT 06260
Phone (860) 963-6331

320 Pomfret St
#2
Putnam, CT 06260

Interoperability endpoints

  • Direct secure messaging: priyanka.tadepalli.1@1694.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/1694/brand/19/csg/48/fhir/r4

Organizations & group practices 1

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": "1598140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1942812623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-3370",
            "fax_number": "845-333-3372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-3370",
            "fax_number": "845-333-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADEPALLI",
        "first_name": "PRIYANKA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-23",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "383161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ptadepalli58727@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "address_1": "707 E Main St",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109402650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.