NPIMap

Individual provider Active NPI

Jyothi Dyavanapalli Gudla, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Canton, OH
National Provider Identifier
1194872713
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
35.083145 Issued in OH
Practice address
4808 Munson St NW
Canton, OH 44718-3613
Phone
(330) 622-0207
Fax
(330) 832-3499
NPI assigned
Jan 4, 2007
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 35-083145 OH
Internal Medicine Physician 207R00000X 35-083145 OH
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 35.083145 OH Primary
Internal Medicine Physician 207R00000X 35.083145 OH

Addresses

Primary practice location

4808 Munson St NW
Canton, OH 44718-3613

Mailing address

4808 Munson St NW
Canton, OH 44718-3613
Phone (330) 460-4115

Other names 1

  • Dr. Jyothi D Gudla Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gudla@novushw.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090707000248 OH Practitioner - Internal MedicinePractitioner - Geriatric Medicine 1254318975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
NeogeriatricsGroup PAC ID 7618022849, 3 clinicians

Practice addresses (Care Compare)

4808 Munson St NW
Canton, OH 44718-3613
Phone (330) 622-0207

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Neogeriatrics Geriatric Medicine CurrentSince Jul 20, 2009 Accepting new patients
Stone Crossing Skilled Care, LLC Past Accepting new patients
Inpatient Medical Services, Inc. Internal Medicine Past Accepting new patients
Smithville Western Inc. Past Accepting new patients
Avis Leasing Co., LLC Past Accepting new patients
Provide a Care Inc Past Accepting new patients
Rose Lane Health and Rehabilitation Inc. Past Accepting new patients
Progressive Morning Care LLC Past Accepting new patients
Astoria SNF, Inc. Past Accepting new patients
Pavilion at Edgefield, LLC Past Accepting new patients

Locations

4808 Munson St NW
Canton, OH 44718
Phone (330) 460-4115

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Pavilion at Canal Fulton for Nursing and RehabilitationCanal Fulton, OH, CCN 366271 Skilled nursing facility Adp of the SNF Dec 16, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1194872713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4808 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183613",
            "telephone_number": "330-460-4115",
            "fax_number": "330-832-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4808 MUNSON ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183613",
            "telephone_number": "330-622-0207",
            "fax_number": "330-832-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDLA",
        "first_name": "JYOTHI",
        "middle_name": "DYAVANAPALLI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35-083145",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-083145",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35.083145",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.083145",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gudla@novushw.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4808 Munson St NW",
            "city": "Canton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "447183613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JYOTHI",
            "last_name": "GUDLA",
            "middle_name": "D",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.