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1639656499

NPI Code Detail

MEDICARE: BHARATH PENDYALA

MEDICARE: BHARATH PENDYALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125071674	IL
2	208M00000X	Hospitalist Physician	CP1871	NE
3	208M00000X	Hospitalist Physician	MD-56248	IA

General Provider Information

NPI Number	:	1639656499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHARATH PENDYALA

Provider Business Mailing Address
First Line	:	7500 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2319
Country	:	US
Telephone Number	:	855-524-4001
Fax Number	:	402-398-5589

Provider Business Practice Location Address
First Line	:	7500 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2319
Country	:	US
Telephone Number	:	855-524-4001
Fax Number	:	402-398-5589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	01/20/2026

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Directions to “ BHARATH PENDYALA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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