DR. PRATAP REDDY TUMMALA MD
NPI 1730187816
Internal Medicine - Rheumatology in Sherman, TX

Active since July 12, 2005PECOS EnrolledAccepts Medicare Assignment
65.74/100
CMS Quality Rating
1107 SARA SWAMY DR, SHERMAN, TX 75090(903) 891-9303(903) 893-9604 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 11, 2025, May 19, 2022 (2 updates tracked since 2022).

About Dr. Pratap Reddy Tummala Md NPPES

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

DR. PRATAP REDDY TUMMALA MD (NPI 1730187816) is an individual rheumatology provider in Sherman, Texas, licensed in Texas (L2713) and active in the NPI registry since July 2005. He is enrolled in Medicare PECOS, is affiliated with Choctaw Nation Health Services Authority, and is a graduate of Other (1991).

NPPES Registry Identity

NPI1730187816
Entity TypeIndividualMale
Primary Taxonomy207RR0500X
Provider Legal NameDR. PRATAP REDDY TUMMALACredential: MD
Location Address1107 SARA SWAMY DRSherman, TX 75090-1779
Mailing Address1107 Sara Swamy DriveSherman, TX 75090-1779 · (903) 891-9303 · Fax (903) 893-9604
Fax(903) 893-9604
Sole ProprietorNo
Medical School CMSOtherGraduated 1991
Enumeration DateJuly 12, 2005
Last NPPES UpdateApril 11, 20252 updates tracked since enumeration
NPPES CertifiedApril 11, 2025
NPI 1730187816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
License Licensed in TX · L2713
Definition
An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
1107 SARA SWAMY DR, Sherman, TX 75090

Other Identifiers 3

Medicaid161230101TX
Medicaid146496802TX
Other8J6030TX · Blue Cross Provider Numbe

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Pratap Reddy Tummala Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749371581
PECOS Enrollment IDI20110303000915
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.

Areas of Expertise CMS Part B claims 22

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) J0717
Certolizumab pegol is a medication injected under a doctor's supervision. It's used to treat certain inflammatory conditions like rheumatoid arthritis. The injection helps reduce symptoms like pain and swelling. Note that this drug isn't for self-administration.
22,600 services11 patients
Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301
Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.
2,357 services317 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
1,545 services642 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
947 services454 patients
X-ray of hand, minimum of 3 views 73130
An X-ray of the hand, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones in your hand from different angles. This helps in diagnosing fractures, infections, arthritis, or other abnormalities. It's quick and painless.
407 services211 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
343 services173 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Choctaw Nation Health Services Authority

Acute Care Hospitals · Talihina, OK
OwnershipTribal
CMS Certification Number370172
Location1 Choctaw WayTalihina, OK 74571 · Latimer County
Emergency services Birthing friendly

Paris Regional Medical Center

Acute Care Hospitals · Paris, TX
2/5 CMS rating
OwnershipProprietary
CMS Certification Number450196
Location865 Deshong DrParis, TX 75460 · Lamar County
Emergency services Birthing friendly

Texoma Medical Center

Acute Care Hospitals · Denison, TX
3/5 CMS rating
OwnershipProprietary
CMS Certification Number450324
Location5016 S Us Highway 75Denison, TX 75020 · Grayson County
Emergency services Birthing friendly

Tmc- Bonham Hospital

Critical Access Hospitals · Bonham, TX
OwnershipGovernment - Hospital District or Authority
CMS Certification Number451370
Location504 Lipscomb StreetBonham, TX 75418 · Fannin County
Emergency services

Baylor Scott And White Surgical Hospital At Sherma

Acute Care Hospitals · Sherman, TX
2/5 CMS rating
OwnershipPhysician
CMS Certification Number670076
Location3601 Calais DriveSherman, TX 75090 · Grayson County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75090 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
$126.40 typical visit price
range $54.84 – $166.88
Typical copayment $31.60 (range $13.71 – $41.72)
Most-billed visit code 99204
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

65.74/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality67.52
Improvement Activities40
Cost42.43

Reported Quality Measures

Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
97%4,099 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
42%1,571 patients2/55-star benchmark: 100%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
1%159 patients1/55-star benchmark: 98%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
2%1,365 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
24%1,978 patients1/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
8%194 patients1/55-star benchmark: 100%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
85%1,365 patients4/55-star benchmark: 100%
Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier
Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient's history to determine if they have had appropriate management for a recent or…
13%83 patients
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
4%1,365 patients1/55-star benchmark: 79%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES

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

Internal Medicine (Rheumatology)
1107 SARA SWAMY DR
SHERMAN, TX 75090

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 Pratap Tummala's NPI number?

The NPI number for Pratap Tummala is 1730187816. It was assigned to this individual provider in the NPPES registry on July 12, 2005.

Where is Pratap Tummala located?

Pratap Tummala practices at 1107 Sara Swamy Dr, Sherman, TX 75090. The listed phone number is (903) 891-9303.

What is Pratap Tummala's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Is Pratap Tummala enrolled in Medicare?

Yes. Pratap Tummala is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Pratap Tummala accept?

Health plans from UnitedHealthcare list Pratap Tummala 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.

Is Pratap Tummala affiliated with any hospitals?

According to CMS data, Pratap Tummala is affiliated with Choctaw Nation Health Services Authority, Paris Regional Medical Center, Texoma Medical Center, Tmc- Bonham Hospital and Baylor Scott And White Surgical Hospital At Sherma.

When was this NPI record last updated?

The NPPES record for Pratap Tummala was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.