REDDY S REGANTI MD, NPI 1952396277 — WEST BURLINGTON (IA)

NPI 1952396277

14+ Years Experience Individual

REDDY S REGANTI MD

09/13/2005
PROVIDER ENUMERATION DATE
07.09.2007
LAST UPDATE DATE
1952396277
NPI NUMBER

About REDDY S REGANTI

REDDY S REGANTI is a provider established in WEST BURLINGTON, IA. The NPI number of REDDY S REGANTI is 1952396277 and was assigned on 09/13/2005. The practitioners primary taxonomy code is: 2085R0001X with license number: 22977 IA .

Mailing address

  • City: WEST BURLINGTON
  • State: IA
  • Postal code: 526551691
  • Phone: 3197531220
  • Fax: 3197535464
  • Address: 1225 S GEAR AVE
  • Address 2: SUITE 152

Primary Practice Address

  • Region : WEST BURLINGTON, IA
  • NPI : 1952396277
  • Phone : 3197531220
  • Fax : 3197535464
  • Postalcode : 526551691
  • Address : 1225 S GEAR AVE SUITE 152

Additional identifiers

  • Identifier: 32196
  • Code / Type : 1 - other
  • Identifier state : IA
  • Identifier issuer: CCA-BCBS OF IA PROV NUMB

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 3213017
  • Code / Type : 5 - MEDICAID
  • Identifier state : IA

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0001X
  • License number: 22977
  • License state: IA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.

Contacts:

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  • REDDY S REGANTI MD
  • Address : 1225 S GEAR AVE SUITE 152
  • Region : WEST BURLINGTON, IA
  • NPI : 1952396277
  • Phone : 3197531220
  • Fax : 3197535464
  • Postalcode : 526551691

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1225 S GEAR AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 152
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameWEST BURLINGTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code526551691
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3197531220
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3197535464
The fax number associated with the location address of the provider being identified.
NPI1952396277
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0001X
A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Provider Enumeration Date09/13/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.09.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)REDDY S REGANTI
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1225 S GEAR AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 152
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameWEST BURLINGTON
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code526551691
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3197531220
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3197535464
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #12085R0001X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Provider License Number 122977
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 132196
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IA
Other Provider Identifier State #1
Other Provider Identifier Issuer 1CCA-BCBS OF IA PROV NUMB
Other Provider Identifier Issuer #1
Other Provider Identifier 23213017
Other Provider Identifier #2
Other Provider Identifier Type 25
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2IA
Other Provider Identifier State #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorX
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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