Individual provider Active NPI

Babuji Reddy Gandra, MBBS/MD

  • Psychiatry Physician
  • Davenport, IA
National Provider Identifier
1215184726
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD-43540 Issued in IA
Practice address
4455 E 56TH St
Davenport, IA 52807-2995
Phone
(635) 355-2577
Fax
(563) 355-4015
NPI assigned
Aug 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X EMC0004046 MI
Psychiatry Physician 2084P0800X MD-43540 IA Primary

Addresses

Primary practice location

4455 E 56TH St
Davenport, IA 52807-2995

Mailing address

4455 E 56TH St
Davenport, IA 52807-2995
Phone (563) 355-2577

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address babuji.gandra@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MI2 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
I20160728000024 IA Practitioner - Psychiatry 6800042219 Reassigns benefits to 2 organizations
I20240216001085 MI Practitioner - Psychiatry 6800042219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

1401 W Central Park Ave
Mercyone Genesis Davenport West Med
Davenport, IA 52804-1707
Phone (563) 421-2120

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W. Sparrow Hospital Association Psychiatry CurrentSince Jan 1, 2024 Accepting new patients
Genesis Health System CurrentSince Jan 1, 2020 Accepting new patients
Genesis Health System Current Accepting new patients
Tower Health Medical Group Current Accepting new patients
Genesis Health System CurrentSince Jul 18, 2016 Accepting new patients
Genesis Health System CurrentSince Jan 1, 2020 Accepting new patients
Genesis Health System CurrentSince Jul 18, 2016 Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Jan 1, 2024 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Genesis Health System Past Accepting new patients

Locations

865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667

4455 E 56th St
Davenport, IA 52807
Phone (563) 355-2577

1401 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

619 5th St
Durant, IA 52747
Phone (563) 785-4487

8175 Reliable Pkwy
Chicago, IL 60686

1210 W Saginaw St
Fl 2
Lansing, MI 48915
Phone (517) 364-7575

420 S 5th Ave
West Reading, PA 19611
Phone (484) 628-3637

Interoperability endpoints

  • Direct secure messaging: babuji.gandra@direct.genesishealth.com

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 and National Provider Directory roles.

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": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1215184726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "563-355-2577",
            "fax_number": "563-355-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "635-355-2577",
            "fax_number": "563-355-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDRA",
        "first_name": "BABUJI",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "MBBS/MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "EMC0004046",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "MD-43540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "babuji.gandra@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4455 E 56th St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528072995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.