Dev S Nandamudi, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301063724 Issued in MI

Practice address

3030 Commerce Dr
Fort Gratiot, MI 48059-3819

Phone

(810) 385-9559

Fax

(810) 385-9515

NPI assigned

Feb 27, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dnandamudi@bwchcp-mi.direct.office.nextgen.com
• FHIR API: https://api.platform.athenahealth.com/22735/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Blue Water Children'S Health Care

  • Pediatrics Physician
  • Fort Gratiot, MI
  • NPI 1962003566

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1205802436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 COMMERCE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593819",
            "telephone_number": "810-385-9559",
            "fax_number": "810-385-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 COMMERCE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593819",
            "telephone_number": "810-385-9559",
            "fax_number": "810-385-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANDAMUDI",
        "first_name": "DEV",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301063724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205802436",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fort Gratiot, MI
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.