NPIMap

Individual provider Active NPI

Venkata KR Bodavula, MD

  • Surgery of the Hand (Surgery) Physician
  • Saint Peters, MO
National Provider Identifier
1275714784
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery of the Hand (Surgery) PhysicianTaxonomy code 2086S0105X
License
2010007564 Issued in MO
Practice address
5600 Mexico Rd Ste 21
Saint Peters, MO 63376-1660
Phone
(636) 373-9882
NPI assigned
Nov 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery of the Hand (Surgery) Physician 2086S0105X 2010007564 MO Primary

Addresses

Primary practice location

5600 Mexico Rd Ste 21
Saint Peters, MO 63376-1660

Mailing address

3394 McKelvey Rd Ste 115
Bridgeton, MO 63044-2531
Phone (636) 373-9882

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100720001045 MO Practitioner - Hand Surgery 2961534334 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand Surgery
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bodavula MD LLC 2 clinicians

Practice addresses (Care Compare)

3394 McKelvey Rd
Suite 115
Bridgeton, MO 63044-2531
Phone (636) 373-9882

Hospital & facility affiliations

  • Mercy Hospital Lincoln Hospital, Troy, MO, CCN 261319
  • Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
  • SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
  • SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200
  • St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)30
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bodavula MD LLC CurrentSince Mar 1, 2015 Accepting new patients
North Dallas Pediatrics Associates PC Current Accepting new patients
Barnes Jewish St. Peters Hospital Inc. Past Accepting new patients
Subbarao Polineni, M.D. PC Past Accepting new patients
Major Hospital Past Accepting new patients
Agility Orthopaedics, LLC PastSince Mar 1, 2016 Accepting new patients

Locations

3394 McKelvey Rd
Ste 115
Bridgeton, MO 63044
Phone (314) 643-7692

555 N New Ballas Rd
Ste 175
Saint Louis, MO 63141
Phone (314) 786-2663

5600 Mexico Rd
Ste 21
Saint Peters, MO 63376
Phone (636) 373-9882

1004 E Cherry St
Ste 321
Troy, MO 63379
Phone (636) 373-9882

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 6

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.

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": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1275714784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3394 MCKELVEY RD STE 115",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442531",
            "telephone_number": "636-373-9882",
            "fax_number": "866-283-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 MEXICO RD STE 21",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761660",
            "telephone_number": "636-373-9882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODAVULA",
        "first_name": "VENKATA",
        "middle_name": "KR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-27",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "MO",
            "license": "2010007564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5600 Mexico Rd Ste 21",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633761660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

Verify at the official NPI Registry.