Provider Demographics
NPI:1265572481
Name:VASAMREDDY, CHANDRASEKHAR R (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRASEKHAR
Middle Name:R
Last Name:VASAMREDDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-781-5387
Mailing Address - Fax:417-781-7174
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-781-5387
Practice Address - Fax:417-781-7174
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24539207RC0000X
MOMO-2009008971207RC0000X
KSKSDEA-FV1379646207RC0000X
KS04-33682207RC0000X, 207RC0001X
MO2009008971207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS67A00005OtherMEDICARE PTANK
KSK67000014OtherMEDICARE PTAN
KS200611200AMedicaid
KS450D00003DOtherMEDICARE JOHNSON COUNTY
MO450A00003AOtherMEDICARE JACKSON COUNTY
MO1265572481Medicaid
MO1265572481Medicaid
KS450D00003DOtherMEDICARE JOHNSON COUNTY
MOMA2310008Medicare PIN