Individual provider Active NPI

Vijay Bandhakavi, MD

  • Pulmonary Disease Physician
  • La Crosse, WI
National Provider Identifier
1184887473
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
52157 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601
Phone
(608) 782-7300
NPI assigned
Jul 7, 2008
Last updated
Aug 30, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 52157 WI Primary

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other identifiers 1

IdentifierTypeStateIssuer
1184887473MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120808000880 WI Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 1951557859 Reassigns benefits to 6 organizations
I20210803003225 GA Practitioner - Pulmonary DiseasePractitioner - Sleep Medicine 1951557859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Sleep Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians

Practice addresses (Care Compare)

2409 N Patterson St
Suite 230
Valdosta, GA 31602-2512
Phone (229) 259-4369

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52157WIMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-County Memorial Hospital, Inc. CurrentSince Sep 10, 2018 Accepting new patients
St. Joseph's Health Services, Inc. Current Accepting new patients
SGMC Affiliated Services LLC Current Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Sep 10, 2018 Accepting new patients
Tri-County Memorial Hospital, Inc. Current Accepting new patients
SGMC Physician Network Inc CurrentSince Jul 1, 2021 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Sep 10, 2018 Accepting new patients
Gundersen Clinic LTD CurrentSince Sep 10, 2018 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Sep 10, 2018 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Sep 10, 2018 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc Pulmonary Disease Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Sep 10, 2018 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Sep 10, 2018 Accepting new patients
St. Joseph's Health Services, Inc CurrentSince Sep 10, 2018 Accepting new patients
South Georgia Medical Center Inc Past Accepting new patients
Prohealth Waukesha Memorial Hospital, Inc. Past Accepting new patients

Locations

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

Interoperability endpoints

  • Direct secure messaging: vbandhakavi290138@direct.gundersenhealth.org

Organizations & group practices 18

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 18

Hospital & facility affiliations 1

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": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1184887473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "54601",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDHAKAVI",
        "first_name": "VIJAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "52157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184887473",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.