NPIMap

Individual provider Active NPI

Sudha Koduru, M.D.

  • Internal Medicine Physician
  • Petersburg, VA
National Provider Identifier
1073772455
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01012500380 Issued in VA
Practice address
200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone
(804) 765-5991
NPI assigned
Jun 2, 2008
Last updated
Apr 6, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 01012500380 VA Primary

Addresses

Primary practice location

200 Medical Park Blvd
Petersburg, VA 23805-9274

Mailing address

200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone (804) 765-5991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111107000500 VA Practitioner - HospitalistPractitioner - Internal Medicine 5991978900 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians
Vituity-Virginia Hospitalists PCGroup PAC ID 6507245131, 109 clinicians

Practice addresses (Care Compare)

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

3300 Rivermont Ave
Lynchburg, VA 24503-2030
Phone (434) 200-5999

5801 Bremo Rd
Richmond, VA 23226-1907
Phone (804) 285-2011

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01012500380VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Fredericksburg, LLC Internal Medicine CurrentSince Dec 1, 2017 Accepting new patients
Vituity-Virginia Hospitalists PC CurrentSince Oct 15, 2022 Accepting new patients
Centra Medical Group, LLC CurrentSince Aug 1, 2025 Accepting new patients
True North Health Navigation LLC CurrentSince Dec 1, 2021 Accepting new patients
Hospitalist Medicine Physicians of Virginia LLC Internal Medicine CurrentSince May 6, 2017 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

140 Vista Centre Dr
Fl 2
Forest, VA 24551
Phone (434) 200-2297

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

8260 Atlee Rd
Mechanicsvlle, VA 23116
Phone (804) 264-6000

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

7200 Glen Forest Dr
Ste 106
Richmond, VA 23226
Phone (804) 495-0053

759 S Main St
Woodstock, VA 22664
Phone (540) 459-1100

Organizations & group practices 6

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1073772455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODURU",
        "first_name": "SUDHA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-02",
        "last_updated": "2015-04-06",
        "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": "VA",
            "license": "01012500380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.