RAVI KONIDALA (NPI# 1124013552) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124013552 |
| Entity Type | Individual |
| Full Name | RAVI KONIDALA |
| Credential | MD |
| Practice Address |
1050 E Loop 304 Suite 200, Etmc Rural Health Clinic Crockett TX 75835-1814 |
| Mailing Address |
511 Heath St Crockett TX 75835-2290 |
| Practice Telephone | 9365445132 |
| Practice Fax Number | 9365448029 |
| Mailing Telephone | 9362040600 |
| Mailing Fax Number | 9365448029 |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2011-06-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | M6981 | TX | Allopathic & Osteopathic Physicians |
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
M6981 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1010424560001 | 05 |
| Street Address |
1050 E LOOP 304 SUITE 200, ETMC RURAL HEALTH CLINIC |
| City | CROCKETT |
| State | TX |
| Zip Code | 75835-1814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487155990 | Crockett Medical Center, LLC | Internal Medicine | 1050 E Loop 304, Crockett, TX 75835 | 2018-02-21 |
| 1659826626 | Bryan Scott Shaver | Physician Assistant | 1050 E Loop 304, Suite 200, Crockett, TX 75835-1814 | 2016-08-19 |
| 1982088639 | Hurlburt Family Practice Pllc | Family Medicine | 1050 E Loop 304, Suite 210, Crockett, TX 75835-1814 | 2015-07-13 |
| 1205216090 | Timberlands Healthcare, LLC | Clinic/Center | 1050 E Loop 304, Suite 200, Crockett, TX 75835-1814 | 2015-06-05 |
| 1942318035 | Joseph Henderson Holcomb | Dentist | 1050 E Loop 304, Suite #120, Crockett, TX 75835-1814 | 2006-08-28 |
| 1598873614 | John Mahlon Stovall Jr. | Dentist | 1050 E Loop 304, Suite #120, Crockett, TX 75835-1814 | 2006-08-28 |
| 1487614616 | Craig Mcmullen | Family Medicine | 1050 E Loop 304, Crockett, TX 75835-1814 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568012862 | Ruby R. Adler | Technician | 2301 N 4th Street, Crockett, TX 75835 | 2019-09-18 |
| 1366712978 | Traditions Hospice of Madisonville, LLC | Hospice Care, Community Based | 600e Loop 304, Crockett, TX 75835 | 2012-01-12 |
| 1538458633 | Northeast Texas Home Health Agency Ltd | Home Health | 2001 E Houston Ave, Crockett, TX 75835 | 2011-03-30 |
| 1508096553 | D&c Medical Associates | Family Medicine | 1100 Loop 3048 East, Suite 200, Crockett, TX 75835 | 2009-07-23 |
| 1356466346 | John Vernon Garner | Dentist | 102 North Grace, Crockett, TX 75835 | 2007-03-20 |
| 1023148467 | Houston County Home Health Care, Inc. | Durable Medical Equipment & Medical Supplies | 1703 E Hwy 21 E, Crockett, TX 75835 | 2007-03-06 |
| 1407944382 | Davy Crockett Drug, Inc. | Pharmacy | 107 S 4th St, Crockett, TX 75835 | 2006-10-10 |
| 1437177052 | John Allan Burnett | Emergency Medicine | 1100 Loop 340 E, Crockett, TX 75835 | 2006-07-18 |
| 1720022593 | Stanley Roger Speegle | Family Medicine | 1100 Loop 304 East, Crockett, TX 75835 | 2006-06-15 |
| 1649219809 | Jeanne M. Hopple | Nurse Practitioner | The Heart Institute of East Texas, Crocket, 951 E. Loop 304, Crockett, TX 75835 | 2006-06-05 |
| Find all providers in zip 75835 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508096553 | D&c Medical Associates | Family Medicine | 1100 Loop 3048 East, Suite 200, Crockett, TX 75835 | 2009-07-23 |
| 1720022593 | Stanley Roger Speegle | Family Medicine | 1100 Loop 304 East, Crockett, TX 75835 | 2006-06-15 |
| 1134111263 | Christopher R Haeckler | Family Medicine | 1122 E Loop 304, Crockett, TX 75835-1810 | 2005-08-16 |
| 1982088639 | Hurlburt Family Practice Pllc | Family Medicine | 1050 E Loop 304, Suite 210, Crockett, TX 75835-1814 | 2015-07-13 |
| 1215974688 | Iron Mountain Medical Center LLC | Family Medicine | 106 N Grace St, Crockett, TX 75835-1722 | 2006-06-02 |
| 1487614616 | Craig Mcmullen | Family Medicine | 1050 E Loop 304, Crockett, TX 75835-1814 | 2006-03-23 |
| 1457329039 | Everett Perry Ramsey IIi | Family Medicine | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-03-09 |
| 1285626911 | Crockett Clinic LLP | Family Medicine | 1122 E Loop 304, Crockett, TX 75835-1810 | 2005-08-18 |
| 1376535419 | Richard J Kelly | Family Medicine | 1122 E Loop 304, Crockett, TX 75835-1810 | 2005-08-16 |
| 1376535542 | Frank A Smith | Family Medicine | 1122 E Loop 304, Crockett, TX 75835-1810 | 2005-08-16 |
| Find all providers in CROCKETT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.