NPIMap

Individual provider Active NPI

Sudha Pidikiti, M.D.,

  • Nephrology Physician
  • Vancouver, WA
National Provider Identifier
1275623563
Registry record updated Nov 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD60044234 Issued in WA
Practice address
700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone
(360) 397-1500
Fax
(360) 253-3515
NPI assigned
Oct 15, 2006
Last updated
Nov 3, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 49177-020 WI
Nephrology Physician 207RN0300X MD25928 OR
Nephrology Physician 207RN0300X MD60044234 WA Primary

Addresses

Primary practice location

700 NE 87TH Ave
Vancouver, WA 98664-1913

Mailing address

700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 397-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20081119000838 WA Practitioner - NephrologyPractitioner - Internal Medicine 7113959651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 882-2778

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD25928ORMDNephrology Physician
MD60044234WAMDNephrology Physician
49177-020WIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS Nephrology CurrentSince Dec 1, 2008 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Dec 1, 2008 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

700 NE 87th Ave
Ste 270
Vancouver, WA 98664
Phone (360) 882-2277

Interoperability endpoints

  • Direct secure messaging: spidikiti2181@tvc-direct.org

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 6

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": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225670400000",
    "number": "1275623563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-397-1500",
            "fax_number": "360-253-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-397-1500",
            "fax_number": "360-253-3515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIDIKITI",
        "first_name": "SUDHA",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2008-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "49177-020",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OR",
            "license": "MD25928",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "MD60044234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.