Sudha Pravinkumar, M.D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.124024 Issued in IL

Practice address

2377 Bloomington Ave
Ste B
Streator, IL 61364

Phone

(815) 672-1382

Fax

(815) 672-5469

NPI assigned

Dec 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Sudha Sadanand Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM, WA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spravinkumar3998905@ghc.direct-ci.net

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.

• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Seattle, WA
  • NPI 1396810701
  Medicare reassignment NPD
• Presbyterian Healthcare Services

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1104802354
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1386935351
  NPD
• Presbyterian Healthcare Services

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470

  Internal Medicine

  NPD
• Presbyterian Healthcare Services

  • Critical Access Hospital
  • Socorro, NM
  • NPI 1790761138

  Internal Medicine

  NPD

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1215266036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2377 BLOOMINGTON AVE",
            "address_2": "STE B",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "61364",
            "telephone_number": "815-672-1382",
            "fax_number": "815-672-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2377 BLOOMINGTON AVE",
            "address_2": "STE B",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "61364",
            "telephone_number": "815-672-1382",
            "fax_number": "815-672-5469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Pottery Ave",
            "address_purpose": "LOCATION",
            "city": "Port Orchard",
            "state": "WA",
            "postal_code": "983663711",
            "country_code": "US",
            "telephone_number": "360-895-5000",
            "fax_number": "360-895-5034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRAVINKUMAR",
        "first_name": "SUDHA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-08",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.124024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1400 Pottery Ave",
            "city": "Port Orchard",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983663711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUDHA",
            "last_name": "SADANAND",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Phillips Investments, LLC - Streator Operations Series
• Kristy Ann Pierce-Schultz, LCSW
• Michelle Pitstick, OT
• Robert Patrick Pode, D.O.
• Podzamsky Medical Services
• Kaleb James Pytel, PT, DPT
• Qus Inc
• Monelyn R Rabago, PT
• Tracy Eileen Rampick
• Julie Ramza, RPH

• Internal Medicine Physician in Streator, IL
• Providers in Streator, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.