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SHANTA A PURUSHOTHAM MD PA
NPI 1790729044
Internal Medicine - Rheumatology in Brooksville, FL

Active since June 16, 2006CLIA 10D0296447 · Waiver
711 HARVARD ST, BROOKSVILLE, FL 34601(352) 799-0135(352) 754-5394 Get Directions Write a Review

NPPES record last updated: September 23, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shanta A Purushotham Md Pa NPPES

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

SHANTA A PURUSHOTHAM MD PA (NPI 1790729044) is a healthcare organization registered as a rheumatology in Brooksville, Florida and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Shanta A Purushotham, Md, as its authorized official.

NPPES Registry Identity

NPI1790729044
Entity TypeOrganization
Primary Taxonomy207RR0500X
Legal Business NameSHANTA A PURUSHOTHAM MD PA
Location Address711 HARVARD STBrooksville, FL 34601-2842
Mailing Address711 Harvard StBrooksville, FL 34601-2842 · (352) 799-0135 · Fax (352) 754-5394
Phone(352) 799-0135
Fax(352) 754-5394
Organization SubpartNo
Authorized OfficialShanta A PurushothamMd · (352) 799-0135
Enumeration DateJune 16, 2006
Last NPPES UpdateSeptember 23, 2011
✔ NPI 1790729044 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
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.
711 HARVARD ST, Brooksville, FL 34601
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Other Identifiers 2

Medicare PIN26094AFL
Medicaid376671300FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0296447

Shanta A Purushotham MD PA · Brooksville, FL
Active · expires Aug 31, 2026
CLIA Number10D0296447
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorShanta A. Purushotham MD
Laboratory Phone(352) 799-0135
Laboratory LocationShanta A Purushotham MD PA711 Harvard Street, Brooksville, FL 34601
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Shanta A Purushotham MD PA's NPI number?

The NPI number for Shanta A Purushotham MD PA is 1790729044. It was assigned to this organization in the NPPES registry on June 16, 2006.

Where is Shanta A Purushotham MD PA located?

Shanta A Purushotham MD PA is located at 711 Harvard St, Brooksville, FL 34601. The listed phone number is (352) 799-0135.

What is Shanta A Purushotham MD PA's specialty?

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

Does Shanta A Purushotham MD PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0296447) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shanta A Purushotham MD PA was last updated on September 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.