Noah Praveen Kumar Kondamudi, M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

25MA06802600 Issued in NJ

Practice address

30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000

Phone

(973) 972-0037

NPI assigned

Jul 5, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: nkondamudi8796@prd.direct.tbh.org

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.

• TBHC Pediatric Services PC

  • Pediatrics Physician
  • Brooklyn, NY
  • NPI 1861628091

  Pediatric Emergency Medicine

  Medicare reassignment NPD
• The Brooklyn Hospital Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1326046467
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114958451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST",
            "address_2": "ADMC 12 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST",
            "address_2": "ADMC 12 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000",
            "telephone_number": "973-972-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDAMUDI",
        "first_name": "NOAH",
        "middle_name": "PRAVEEN KUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NJ",
            "license": "25MA06802600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8778205",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Koh
• Eniola O Kolawole, PHARMD
• Maria Gabriella Koliver, MD
• Shilpa Kolli
• Claudia Komer, DO
• Sankeerth Kumar Kondapalli
• Baburao Koneru, M.D.
• Kalyan Koneru, MD
• Yini Kong
• Yu Kong, MD

• Pediatric Emergency Medicine (Pediatrics) Physician in Newark, NJ
• Providers in Newark, NJ by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.