Swaroop N Nyshadham MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

013121 Issued in AL

Legal business name

SWAROOP N NYSHADHAM MD

Practice address

4503 20TH Ave
Valley, AL 36854

Phone

(334) 756-8190

Fax

(334) 756-5158

NPI assigned

Feb 15, 2008

Reactivated

Feb 11, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Susan H Wood

Title

Office Manager

Phone

(334) 756-8190

Specialties & licenses 6

Addresses

Other identifiers 11

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Swaroop Nyshadham, M.D.

  • General Practice Physician
  • Lagrange, GA
  • NPI 1306892351

  Surgery

  NPD (past)

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1265600977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4503 20TH AVE",
            "city": "VALLEY",
            "state": "AL",
            "postal_code": "36854",
            "telephone_number": "334-756-8190",
            "fax_number": "334-756-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4503 20TH AVE",
            "city": "VALLEY",
            "state": "AL",
            "postal_code": "36854",
            "telephone_number": "334-756-8190",
            "fax_number": "334-756-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWAROOP N NYSHADHAM MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2016-02-11",
        "deactivation_date": "2014-04-07",
        "reactivation_date": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "334-756-8190",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AL",
            "license": "013121",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "031483",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME49553",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AL",
            "license": "013121",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "031483",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME49553",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000082972",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51082972",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000338357F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300041350A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51532898",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCAID",
            "identifier": "009937179",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009937179",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51514838",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000338357B",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "02BDCHN01",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529928300",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Smith, D.P.T.
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• State of Alabama Department of Public Health
• Rachel Elaine Summerlin, OTD, OTR/L
• The Choice Medical Supply Inc.
• The East Alabama Health Care Authority
• The East Alabama Health Care Authority
• The East Alabama Health Care Authority
• The East Alabama Health Care Authority

• General Practice Physician in Valley, AL
• Providers in Valley, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.