Individual provider Active NPI

Sampath Kumar Poreddy, MBBS

  • Gastroenterology Physician
  • Omaha, NE
National Provider Identifier
1174726707
Registry record updated Mar 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
32276 Issued in NE
Practice address
7710 Mercy Rd Ste 2000
Omaha, NE 68124-2323
Phone
(402) 717-9800
Fax
(402) 717-6068
NPI assigned
Jun 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 35.121458 OH
Gastroenterology Physician 207RG0100X 2009018576 MO
Student in an Organized Health Care Education/Training Program 390200000X 2006016389 MO
Student in an Organized Health Care Education/Training Program 390200000X 57.018705 OH
Gastroenterology Physician 207RG0100X 32276 NE Primary

Addresses

Primary practice location

7710 Mercy Rd Ste 2000
Omaha, NE 68124-2323

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311

Other practice location 1

234 Goodman St
Cincinnati, OH 45219-2364
Phone (513) 475-7505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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

Enrollment IDStateProvider typePAC IDDetails
I20200205002381 NE Practitioner - Gastroenterology 6800942368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

7710 Mercy Rd
Suite 2000
Omaha, NE 68124-2323
Phone (402) 717-0820

Hospital & facility affiliations

  • CHI Health Bergan Mercy Hospital, Omaha, NE, CCN 280060
  • CHI Health Immanuel Hospital, Omaha, NE, CCN 280081

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy29
Upper gastrointestinal (GI) endoscopy for acid reflux164

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009018576MOMDGastroenterology Physician
32276NEMDGastroenterology Physician
2006016389MOMDStudent in an Organized Health Care Education/Training Program
57.018705OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Mar 1, 2020 Accepting new patients
Alegent Creighton Clinic Gastroenterology Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

7710 Mercy Rd
Ste 2000
Omaha, NE 68124
Phone (402) 717-0820

16909 Lakeside Hills Ct
Ste 300
Omaha, NE 68130
Phone (402) 758-5400

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1181433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585267200000",
    "number": "1174726707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 2000",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242323",
            "telephone_number": "402-717-9800",
            "fax_number": "402-717-6068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 Goodman St",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452192364",
            "country_code": "US",
            "telephone_number": "513-475-7505",
            "fax_number": "513-475-7355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POREDDY",
        "first_name": "SAMPATH",
        "middle_name": "KUMAR",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-10",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35.121458",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2009018576",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2006016389",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57.018705",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NE",
            "license": "32276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.