Individual provider Active NPI

Vinod A Pallekonda, MD

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1992770978
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01059054A Issued in IN
Practice address
9560 E 59TH St
Indianapolis, IN 46216-1010
Phone
(317) 621-1700
Fax
(317) 621-1711
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01059054A IN Primary

Addresses

Primary practice location

9560 E 59TH St
Indianapolis, IN 46216-1010

Mailing address

5340 Woburn Dr
Indianapolis, IN 46250-2742
Phone (317) 331-3358

Other identifiers 2

IdentifierTypeStateIssuer
000000344907OtherINANTHEM
200930550MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200418000354 IN Order and Referring Only - Family PracticePractitioner - Family Practice 5991773061

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Major Hospital Past Accepting new patients

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": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1992770978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5340 WOBURN DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502742",
            "telephone_number": "317-331-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9560 E 59TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462161010",
            "telephone_number": "317-621-1700",
            "fax_number": "317-621-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLEKONDA",
        "first_name": "VINOD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01059054A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000344907",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200930550",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.