NPIMap

Individual provider Active NPI

Sridhar Reddy Madgula, M.D.

  • Family Medicine Physician
  • Jacksonville, AR
National Provider Identifier
1083808067
Registry record updated Nov 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-6524 Issued in AR
Practice address
1110 W Main St
Jacksonville, AR 72076-4304
Phone
(501) 982-2108
Fax
(501) 982-4951
NPI assigned
Aug 31, 2007
Last updated
Nov 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-6524 AR Primary

Addresses

Primary practice location

1110 W Main St
Jacksonville, AR 72076-4304

Mailing address

1110 W Main St
Jacksonville, AR 72076-4304
Phone (501) 982-2108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20100816000419 AR Practitioner - Family Practice 4688708456 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent Medical GroupGroup PAC ID 5698758803, 237 clinicians

Practice addresses (Care Compare)

1110 W Main St
Jacksonville, AR 72076-4304
Phone (501) 982-2108

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-6524ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group Family Medicine CurrentSince Jul 11, 2010 Accepting new patients
St Vincent Physician Clinics LLC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients

Locations

1110 W Main St
Jacksonville, AR 72076
Phone (501) 982-2108

16221 Saint Vincent Way
Little Rock, AR 72223
Phone (501) 221-0888

Interoperability endpoints

  • Direct secure messaging: smadgula457450@direct.stlukeshealth.org
  • Direct secure messaging: sridhar.madgula@svmgs.eclinicaldirectplus.com

Organizations & group practices 2

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322524800000",
    "number": "1083808067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W MAIN ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764304",
            "telephone_number": "501-982-2108",
            "fax_number": "501-982-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W MAIN ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764304",
            "telephone_number": "501-982-2108",
            "fax_number": "501-982-4951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADGULA",
        "first_name": "SRIDHAR REDDY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-31",
        "last_updated": "2011-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-6524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

Verify at the official NPI Registry.