DR. KEERTHANA NAGAVENKATA BOLISETTY (MD) – Retina Specialist (Ophthalmology) Physician, NPI 1407241284

DR. KEERTHANA NAGAVENKATA BOLISETTY (MD) is a healthcare provider. based in Dallas, Texas. specializing in OPHTHALMOLOGY. They hold the professional credentials MD. They hold a License No. S1985 (TX). The NPI Number for DR. KEERTHANA NAGAVENKATA BOLISETTY (MD) is 1407241284

Main info

Female
11 Years Of Experience
Accepts Medicare Assignment
Name
DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)
NPI
1407241284
Phone
Not provided
Address
5323 HARRY HINES BLVD
Enumeration Date
30 March 2015
Last Update Date
23 October 2022

Doctor Profile

Medical School Name
OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
8176177678
Graduation Year
2015 (11 years ago)
PAC ID
5092023234
Group Practice PAC ID
4183998560
Professional Enrollment ID
I20190626001884
Address ID
TX762445431FO3824XPKWY401
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:11State licenses:1Digital endpointsOther names

1,544 OPHTHALMOLOGY in TX

Provider Addresses for DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)

  • 5323 HARRY HINES BLVD

    DALLAS, TX 753907201

    Phone:

    Type: Mailing

  • 1007 W RANDOL MILL RD STE 110

    ARLINGTON, TX 760126503

    Phone: (817) 617-7678

    Fax: (817) 617-7678

    Type: Location

  • 5323 Harry Hines Blvd

    Dallas, TX 753907201

    Phone: (214) 648-0464

    Type: Location

  • 3824 N Tarrant Pkwy Ste 310

    Fort Worth, TX 762445431

    Phone: (817) 617-7678

    Fax: (817) 617-7681

    Type: Location

  • 3824 N TARRANT PKWY STE 310

    FORT WORTH, TX 762445431

    Phone: (817) 617-7678

    Fax: (817) 617-7681

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 9 Open Payments records for all available years, with a total value of $420.

Total Amount is formed as General ($420) + Research ($0) + Ownership ($0) = $420.

Last reported payment date: 2024-12-13 • Largest payer in this snapshot: Astellas Pharma US Inc ($195).

Total Amount

$420

General + Research + Ownership

Payments

9

Total payment records

General Amount

$420

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-13

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-06-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20190626001884IOphthalmologyTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
92134Imaging of retina346188$0
J0178Injection, aflibercept, 1 mg28653$0
67028Injection of drug into eye16368$0
92202Extended exam of the back part of the eye with optic nerve drawing125103$0
92014Established patient complete exam of visual system11290$0
View full utilization report →

Insurance plans in this area (ZIP 75390)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4183998560View full group profile
NameSpecialtyState
O P H T H A L M O L O G YTX

Reviews

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Frequently asked questions

What unique ID ties claims to DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)?
NPI 1407241284 is assigned to DR. KEERTHANA NAGAVENKATA BOLISETTY (MD) under the national enumeration system.
Is DR. KEERTHANA NAGAVENKATA BOLISETTY (MD) active in the national directory?
DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)'s public NPI profile is in an active state.
What kind of provider is DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)?
The page reflects Retina Specialist (Ophthalmology) Physician for DR. KEERTHANA NAGAVENKATA BOLISETTY (MD). Clinical services aligned with this taxonomy classification.
Where is DR. KEERTHANA NAGAVENKATA BOLISETTY (MD)'s primary listing?
We display Dallas, Texas because that is what the record indicates for DR. KEERTHANA NAGAVENKATA BOLISETTY (MD).
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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