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MALLAREDDY BANALA MD
NPI 1245080159
Student in an Organized Health Care Education/Training Program in Southaven, MS

Active since March 25, 2024PECOS Enrolled
7601 SOUTHCREST PKWY, SOUTHAVEN, MS 38671(662) 772-3607 Get Directions Write a Review

NPPES record last updated: March 25, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mallareddy Banala Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALLAREDDY BANALA MD (NPI 1245080159) is an individual student in an organized health care education/training program in Southaven, Mississippi and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1245080159
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMALLAREDDY BANALACredential: MD
Location Address7601 SOUTHCREST PKWYSouthaven, MS 38671-4739
Mailing Address7601 Southcrest PkwySouthaven, MS 38671-4739 · (662) 772-3607
Phone(662) 772-3607
Sole ProprietorNo
Enumeration DateMarch 25, 2024
NPPES CertifiedMarch 24, 2024
✔ NPI 1245080159 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
7601 SOUTHCREST PKWY, Southaven, MS 38671
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallareddy Banala Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MID-SOUTH ANESTHESIA CONSULTANTS, PLLC
Specialist
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (334) 386-2053
SAIF M TAHSIN MD
Family Medicine
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-2980
SHAN SHAH MD
Internal Medicine
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-2980
KAYLA LAVELLE SWEETEN MD
Student in an Organized Health Care Education/Training Program
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-4696
DYLAN COLLINS GOOLSBY FNP
Nurse Practitioner (Family)
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-4000
BAPTIST MEMORIAL HOSPITAL DESOTO
Specialist/Technologist (Athletic Trainer)
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 349-4000
JONATHAN ANDREW MARTINEZ MD
Student in an Organized Health Care Education/Training Program
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-3607
PRITI PRAKASH EZHUVATHRA MD
Student in an Organized Health Care Education/Training Program
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671
Desoto County (662) 772-3607

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mallareddy Banala's NPI number?

The NPI number for Mallareddy Banala is 1245080159. It was assigned to this individual provider in the NPPES registry on March 25, 2024.

Where is Mallareddy Banala located?

Mallareddy Banala practices at 7601 Southcrest Pkwy, Southaven, MS 38671. The listed phone number is (662) 772-3607.

What is Mallareddy Banala's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mallareddy Banala enrolled in Medicare?

Yes. Mallareddy Banala is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mallareddy Banala was last updated on March 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.