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MS. MANGA TELIDEVARA NP
NPI 1497474373
Nurse Practitioner - Family in Montgomery, TX

Active since August 24, 2022PECOS Enrolled
615 WORSHAM ST, MONTGOMERY, TX 77316(281) 650-0945 Get Directions Write a Review

NPPES record last updated: December 12, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 12, 2024, Aug 24, 2022 (2 updates tracked since 2022).

About Ms. Manga Telidevara Np NPPES

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

MS. MANGA TELIDEVARA NP (NPI 1497474373) is an individual family provider in Montgomery, Texas, licensed in Texas (1090732) and active in the NPI registry since August 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1497474373
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. MANGA TELIDEVARACredential: NP
Location Address615 WORSHAM STMontgomery, TX 77316-4497
Mailing Address615 Worsham StMontgomery, TX 77316-4497 · (281) 650-0945
Phone(281) 650-0945
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateAugust 24, 2022
Last NPPES UpdateDecember 12, 20242 updates tracked since enumeration
NPPES CertifiedDecember 12, 2024
✔ NPI 1497474373 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in TX · 1090732
Also ListedNurse PractitionerTaxonomy 363L00000X · License 1090732 (TX)
615 WORSHAM ST, Montgomery, TX 77316
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Manga Telidevara Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7416325709
PECOS Enrollment IDI20240925000395
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.

Medicare Billing Reassignment

Medicare enrollment records show Manga Telidevara reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

P3 Medical Group PC
1,789 mi
Family Medicine
966 12TH ST SE STE 110
Salem, OR 97302
  • Reassigned Medicare billing, Oregon enrollment
  • 31 clinicians in this Medicare group
NPI 1689266926 (971) 239-0001

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 77316 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Manga Telidevara's NPI number?

The NPI number for Manga Telidevara is 1497474373. It was assigned to this individual provider in the NPPES registry on August 24, 2022.

Where is Manga Telidevara located?

Manga Telidevara practices at 615 Worsham St, Montgomery, TX 77316. The listed phone number is (281) 650-0945.

What is Manga Telidevara's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Manga Telidevara enrolled in Medicare?

Yes. Manga Telidevara is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Manga Telidevara's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Manga Telidevara reassigns Medicare benefits to P3 Medical Group PC (Salem, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Manga Telidevara's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Manga Telidevara accept?

Health plans from Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Manga Telidevara as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Manga Telidevara was last updated on December 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.