NPIMap

Individual provider Active NPI

Venkata Marthanda Sastry Mukkavilli, MD

  • Psychiatry Physician
  • Dallas, TX
National Provider Identifier
1992943658
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
Q3741 Issued in TX
Practice address
6363 Forest Park Rd FL 7
Suite 749
Dallas, TX 75235-5479
Phone
(214) 645-8500
Fax
(214) 648-3775
NPI assigned
Feb 3, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Family Medicine) Physician 207QS1201X Q3741 TX
Psychiatry Physician 2084P0800X 24594 WV
Psychiatry Physician 2084P0800X 0101258929 VA
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X Q3741 TX
Student in an Organized Health Care Education/Training Program 390200000X 233251
Psychiatry Physician 2084P0800X Q3741 TX Primary

Addresses

Primary practice location

6363 Forest Park Rd FL 7
Suite 749
Dallas, TX 75235-5479

Mailing address

PO Box 845347
Dallas, TX 75284-5347
Phone (214) 645-0624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150513001841 TX Practitioner - PsychiatryPractitioner - Sleep Medicine 7618142316 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Sleep Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6363 Forest Park Rd 7TH FL
749 Univ of TX SW Med Ctr Psych
Dallas, TX 75390-9087
Phone (214) 645-8500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q3741TXMDPsychiatry Physician
0101258929VAMDPsychiatry Physician
24594WVMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Psychiatry CurrentSince Aug 5, 2019 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 5, 2019 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Sleep Medicine Current Accepting new patients
Ut Physicians CurrentSince May 1, 2015 Accepting new patients
Ut Physicians Psychiatry CurrentSince May 1, 2015 Accepting new patients
University Healthcare Physicians, Inc. Psychiatry Past Accepting new patients
University of Texas Southwestern Medical Center at Dallas PastSince Aug 6, 2019 Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

5939 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 645-1919

6363 Frst Park Rd 7th Fl
Ste 749
Dallas, TX 75390
Phone (214) 645-8500

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300

Organizations & group practices 7

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.

Hospital & facility affiliations 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1992943658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752845347",
            "telephone_number": "214-645-0624",
            "fax_number": "214-645-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FOREST PARK RD FL 7",
            "address_2": "SUITE 749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752355479",
            "telephone_number": "214-645-8500",
            "fax_number": "214-648-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKAVILLI",
        "first_name": "VENKATA",
        "middle_name": "MARTHANDA SASTRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-03",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS1201X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sleep Medicine",
            "state": "TX",
            "license": "Q3741",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "24594",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101258929",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "TX",
            "license": "Q3741",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "233251",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q3741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.