Kadarnath S Boodram MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101229800 Issued in VA

Legal business name

KADARNATH S BOODRAM MD LLC

Practice address

4300 Crossings Blvd Ste 101
Prince George, VA 23875-1452

Phone

(804) 526-7900

Fax

(804) 526-7195

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Sharon Boodram

Title

Practice Manager

Phone

(804) 526-7900

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• K.S. Boodram, MD PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kadarnath Shammie Boodram, MD

  • Internal Medicine Physician
  • Prince George, VA
  • NPI 1679546923
  Medicare reassignment NPD

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710028800000",
    "number": "1093926552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CROSSINGS BLVD STE 101",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751452",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 CROSSINGS BLVD STE 101",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751452",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Old Wagner Road",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Petersburg",
            "state": "VA",
            "postal_code": "238059313",
            "country_code": "US",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KADARNATH S BOODRAM MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2024-03-10",
        "certification_date": "2024-03-10",
        "status": "A",
        "authorized_official_last_name": "BOODRAM",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "804-526-7900"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101229800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0408689",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "7604973",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010124701",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "8130003",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0504963",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUOTHERN HEALTH",
            "identifier": "254668",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3689195",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARENET",
            "identifier": "54180",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "172714",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7404178",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA",
            "identifier": "94167",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "K.S. Boodram, MD PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "K.S. Boodram, MD PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Prince George, VA
• Providers in Prince George, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.