Mrinalini Sujala Kodumagulla, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

200801499 Issued in NC

Practice address

1831 Lake Pine Dr Ste 200
Cary, NC 27511-6050

Phone

(919) 380-1849

Fax

(919) 380-1851

NPI assigned

Aug 26, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335
• HI PPO

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AFFIBD
• FHIR API: https://fhir4.healow.com/fhir/r4/AFFIBD/Endpoint/AFFIBD
• Direct secure messaging: mrinalini.kodumagulla.1@14693.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/14693/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wake Family Medicine PC

  • General Practice Physician
  • Cary, NC
  • NPI 1215162466

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Straub Clinic & Hospital

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1457306508
  Medicare reassignment NPD
• Straub Clinic & Hospital

  • Community/Retail Pharmacy
  • Honolulu, HI
  • NPI 1295443216
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1043467665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 LAKE PINE DR STE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275116050",
            "telephone_number": "919-380-1849",
            "fax_number": "919-380-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 LAKE PINE DR STE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275116050",
            "telephone_number": "919-380-1849",
            "fax_number": "919-380-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODUMAGULLA",
        "first_name": "MRINALINI",
        "middle_name": "SUJALA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-26",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200801499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5910366",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "02DWB",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Knight, MSW, LCSWA
• Gregory Michael Knoll, MD
• Abby Kane Koch, OTR/L
• Darren Gregory Koch, DDS
• Noelani Kochlani
• Sara Koenig, MD, MBA
• Stephanie Margarete Koenig, LCSW-A
• Erin Koenke, PT, DPT
• Brandon Dale Kofford, DMD
• Kylie Jennifer Kofler, PA-C

• Family Medicine Physician in Cary, NC
• Providers in Cary, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; 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.

Verify at the official NPI Registry.