Active NPI
David Pudalov, MD
- Internal Medicine Physician
- Savannah, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 84897
- Practice address
- 4700 Waters Ave
Hospitalist Office
Savannah, GA 31404-6220 - Phone
- (912) 350-8119
- NPI assigned
- Apr 7, 2017
- Last updated
- Sep 18, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 84897 | GA | Primary |
Addresses
Primary practice location
4700 Waters Ave
Hospitalist Office
Savannah, GA 31404-6220
Mailing address
4700 Waters Ave
Hospitalist Office
Savannah, GA 31404-6220
Phone (912) 350-8119
Other practice location 1
22 S Greene St Rm N3E09
Baltimore, MD 21201-1544
Phone (410) 328-6110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Rochester School of Medicine and Dentistry, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1170 Cleveland Ave
East Point, GA 30344-3615
Phone (404) 466-1170
4700 Waters Ave
Savannah, GA 31404-6220
Phone (912) 350-8000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84897 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cogent Healthcare of Georgia PC | Internal Medicine | Current | Accepting new patients |
| Savannah Health Services, LLC | Past | Accepting new patients |
Locations
1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500
4700 Waters Ave
Savannah, GA 31404
Phone (912) 273-1100
4700 Waters Ave
Ofc
Savannah, GA 31404
Phone (912) 350-8119
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Macon, GA
- NPI 1609827823
-
- Hospitalist Physician
- Savannah, GA
- NPI 1891653655
-
dba Memorial Health University Medical Center
- General Acute Care Hospital
- Savannah, GA
- NPI 1053824292
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Memorial Health University Medical Center
- General Acute Care Hospital
- Savannah, GA
- NPI 1053824292
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1033642822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 WATERS AVE",
"address_2": "HOSPITALIST OFFICE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314046220",
"telephone_number": "912-350-8119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 WATERS AVE",
"address_2": "HOSPITALIST OFFICE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314046220",
"telephone_number": "912-350-8119"
}
],
"practiceLocations": [
{
"address_1": "22 S Greene St Rm N3E09",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212011544",
"country_code": "US",
"telephone_number": "410-328-6110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PUDALOV",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-07",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "84897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.