Sreenivas Koka, DDS is a medicare enrolled "Dentist - Prosthodontics" provider in Leland, Mississippi. His current practice location is
201 Baker Blvd, Leland, Mississippi. You can reach out to his office (for appointments etc.) via phone at
(662) 686-4121.
Sreenivas Koka is licensed to practice in California (license number 63470) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699753319.
Healthcare Provider's Profile
| Full Name | Sreenivas Koka |
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| Gender | Male |
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| Speciality | Dentist - Prosthodontics |
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| Location | 201 Baker Blvd, Leland, Mississippi |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1699753319
- Provider Enumeration Date: 01/03/2006
- Last Update Date: 11/05/2024
Medicare PECOS Information:
- PECOS PAC ID: 2163400912
- Enrollment ID: I20250208000009
Medical Identifiers
Medical identifiers for Sreenivas Koka such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1699753319 | NPI | - | NPPES |
| 587433500 | Medicaid | MN | |
| 33828500 | Medicaid | WI | |
| P00918769 | Other | MN | RAILROAD MEDICARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223P0700X | Dentist - Prosthodontics | 63470 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Sreenivas Koka allows following entities to bill medicare on his behalf.
| Entity Name | Indianola Clinic Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1679673917
PECOS PAC ID: 4688585805
Enrollment ID: O20040211000801 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sreenivas Koka is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Sreenivas Koka, DDS
201 Baker Blvd,
Leland, MS 38756-3401
Ph: (662) 686-4121 | Sreenivas Koka, DDS
201 Baker Blvd,
Leland, MS 38756-3401
Ph: (662) 686-4121 |
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