Pelham Healthcare Associates PLLC
Organization Active NPI Internal Medicine Physician · Pelham, NH
NPI 1154477305 · NPPES record last updated Apr 11, 2024
Key facts
- NPI
- 1154477305
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- PELHAM HEALTHCARE ASSOCIATES PLLC
- Practice address
- 49 Atwood Rd Ste 1
Pelham, NH 03076-3752 - Phone
- (603) 635-2802
- Fax
- (603) 635-3070
- NPI assigned
- Jan 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Srilatha Kodali, MD
- Title
- Owner
- Phone
- (603) 635-2802
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 8
-
Srilatha Kodali, M.D.
-
Hung Q. Vo, M.D
-
Michelle Connolly, FNP-BC
-
Brittany Sawicki, NP
-
Chanliny Lim, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 30D0085254 | Pelham Healthcare Associates PLLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NH, MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060131000107 | NH | Part B Supplier - Clinic/Group Practice | 3375557267 |
Receives reassigned benefits from 4 practitioners Practice locations: Pelham, NH |
| O20240424000182 | MA | Part B Supplier - Clinic/Group Practice | 3375557267 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment Practice locations: Westford, MA |
National Provider Directory
- Tax ID family
- Pelham Healthcare Associates
Locations
198 Littleton Rd
Ste 203
Westford, MA 01886
Phone (978) 955-2804
49 Atwood Rd
Ste 1
Pelham, NH 03076
Phone (603) 635-2802
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
49 Atwood Rd Ste 1
Pelham, NH 03076-3752
Mailing address
49 Atwood Rd Ste 1
Pelham, NH 03076-3752
Phone (603) 635-2802
Other practice location 1
198 Littleton Rd Ste 203
Westford, MA 01886-3429
Phone (978) 955-2804
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3197352 | Medicaid | MA | |
| 30200262 | Medicaid | NH |
Other providers in Pelham, NH
- Robert Matthew O'Connell
- Tatiana Obukhov
- Michaly Oxner
- Cassandra Passamonte
- Pelham Family Chiropractic, LLC
- Madeline Perry
- Christian Erik Peterson
- Morgan Pinksten
- Progress Not Perfection LLC
- Lindsay Prudhomme
All providers in Pelham, NH · Internal Medicine Physician in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.