Mahidhar Mahasamudram Reddy, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA11750000 Issued in NJ

Practice address

1199 Pleasant Valley Way
West Orange, NJ 07052-1424

Phone

(973) 830-7694

NPI assigned

Apr 12, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/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.

• David Yakobashvili,MD,LLC

  • Internal Medicine Physician
  • Chester, NJ
  • NPI 1306097548
  Medicare reassignment NPD
• New Jersey Sports Medicine LLC.

  • Physical Medicine & Rehabilitation Physician
  • Parsippany, NJ
  • NPI 1790923480
  Medicare reassignment NPD
• Regenespine, LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Pennington, NJ
  • NPI 1689142622
  NPD (past)

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1114451630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CEDAR GATE DR",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "07039",
            "telephone_number": "848-992-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 PLEASANT VALLEY WAY",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521424",
            "telephone_number": "973-830-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "MAHIDHAR",
        "middle_name": "MAHASAMUDRAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-12",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA11750000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raydiant Aesthetics & Wellness LLC
• Mark Lancel Trespalacioreal Rayos del Sol, OTR/L
• Kassandra Reagan, PT, DPT
• Maria L Rebelo, LCSW
• Janelle Rebustes
• Aimee Redisch
• Lynn R Reed, M.A., CCC-SLP
• Nalesha D Reed, LSW
• Edlyn Regalado
• Regional Women'S Health Group, LLC

• Internal Medicine Physician in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.