NPIMap

Individual provider Active NPI

Madhavi Reddy Cherukula, MD

  • Internal Medicine Physician
  • Appleton, WI
National Provider Identifier
1265847396
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
76645 Issued in WI
Practice address
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone
(920) 225-7875
NPI assigned
Jun 26, 2014
Last updated
Mar 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 30174 NE
Internal Medicine Physician 207R00000X 76645 WI Primary
Hospitalist Physician 208M00000X 30174 NE
Hospitalist Physician 208M00000X MD-47285 IA

Addresses

Primary practice location

2600 S Heritage Woods Dr
Appleton, WI 54915-1408

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 228-7875

Other practice location 1

800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone (855) 524-4001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220405002269 WI Practitioner - Internal Medicine 6204107089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone (920) 225-7720

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-47285IAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated Single Specialty CurrentSince Mar 22, 2022 Accepting new patients
Thedacare, Incorporated Single Specialty CurrentSince Mar 22, 2022 Accepting new patients
NSH Shawano-Evergreen LLC Past Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: mcherukula323117@direct.thedacare.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Health ServicesShawano, WI, CCN 525343 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1403740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1265847396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-228-7875",
            "fax_number": "920-993-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S HERITAGE WOODS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151408",
            "telephone_number": "920-225-7875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 MERCY DR",
            "address_purpose": "LOCATION",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515033128",
            "country_code": "US",
            "telephone_number": "855-524-4001",
            "fax_number": "712-325-2499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHERUKULA",
        "first_name": "MADHAVI REDDY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-26",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "30174",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "76645",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NE",
            "license": "30174",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IA",
            "license": "MD-47285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.