Srinivas Kolla, MD
Individual provider Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Weston, WI
NPI 1235100397 · NPPES record last updated Dec 21, 2021
Key facts
- NPI
- 1235100397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- License
- 71626 (WI)
- Practice address
- 3400 Ministry Pkwy
Weston, WI 54476-5220 - Phone
- (715) 393-1000
- Fax
- (715) 393-1469
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Thoracic Surgery
- Education
- Stanford University School of Medicine, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McLeod Physician Associates II
Practice addresses (Care Compare)
555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-7000
800 E Cheves St
Florence, SC 29506-2650
Hospital & facility affiliations
- McLeod Home Health Inc
- McLeod Regional Medical Center-Pee Dee
- McLeod Loris Hospital
- McLeod Health Clarendon
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary artery bypass graft (CABG) | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210601000212 | WI | Practitioner - Cardiac Surgery |
1153220074 | Reassigns benefits to 2 organizations |
| I20210721000126 | SC | Practitioner - Thoracic Surgery | 1153220074 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01063060A | IN | MD | Surgery Physician |
| 036132466 | IL | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| McLeod Physician Associates II | Surgery | Current |
Accepting new patients |
| Marshfield Clinic Inc | Surgery | Current |
Accepting new patients |
| McLeod Physician Associates II | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current | Accepting new patients | |
| McLeod Regional Medical Center of the Pee Dee, Inc. | Past | Accepting new patients | |
| Bethany Hospice Services of Western Pennsylvania, LLC | Past | Accepting new patients | |
| Independent Apn, LLC | Past | Accepting new patients |
Locations
800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337
800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950
506 E Cheves St
#202
Florence, SC 29506
3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
3400 Ministry Pkwy
Weston, WI 54476
Phone (715) 393-1000
Interoperability endpoints
- srinivas.kolla@marshfieldclinichealthsystem.cernerdirect.com
- skolla19738@directmcleodehealth.org
- him@marshfieldclinichealthsystem.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 01063060A | IN | |
| Vascular Surgery Physician | 2086S0129X | 036132466 | IL | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 036132466 | IL | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 71626 | WI | Yes |
Addresses
Primary practice location
3400 Ministry Pkwy
Weston, WI 54476-5220
Mailing address
3400 Ministry Pkwy
Weston, WI 54476-5220
Phone (715) 393-1000
Other practice location 1
2650 Warrenville Rd
Suite 280
Downers Grove, IL 60515-1748
Phone (630) 324-7900
Other practice location 2
700 S Park St Ste A
Madison, WI 53715-1830
Phone (608) 251-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235100397 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | him@marshfieldclinichealthsystem.cernerdirect.com |
Other providers in Weston, WI
- Samantha Lee Klebe
- Nadine M Klesmith
- Thomas A Klinkhammer
- Jackie Kluever
- Lisa Knoll
- Rebecca Ann Kollross
- Bradley Thomas Kook
- Elroy David Koskey
- Philip J Kostka
- Nicole Kraft
All providers in Weston, WI · Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.