Banerje Koduru, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01010300086 Issued in VA

Practice address

207 N 4TH Ave
Hopewell, VA 23860-2503

Phone

(804) 541-0918

Fax

(804) 541-7924

NPI assigned

Aug 9, 2006

Last updated

Sep 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1973

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Virginia South Psychiatric and Family ServicesGroup PAC ID 3476443797, 35 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72142

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.

• Virginia South Psychiatric & Family Services

  • Psychiatry Physician
  • Petersburg, VA
  • NPI 1700894466
  Medicare reassignment Care Compare group NPD
• Hanover County Board of Supervisors

  • Mental Health Counselor
  • Ashland, VA
  • NPI 1104858653
  NPD (past)
• Hanover County Board of Supervisors

  dba Hanover Fire EMS

  • Ambulance
  • Hanover, VA
  • NPI 1245275403
  NPD (past)
• Prakash G Ettigi MDPC

  dba Panic Anxiety and Depression center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Richmond, VA
  • NPI 1699793711
  NPD (past)
• Three Rivers Treatment Center LLC

  dba Three Rivers Treatment Center

  • Psychiatric Residential Treatment Facility
  • Kenbridge, VA
  • NPI 1568827780
  NPD (past)
• Early Autism Services, LLC

  • Behavior Analyst
  • Countryside, IL
  • NPI 1700130713
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378771200000",
    "number": "1285644104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N 4TH AVE",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238602503",
            "telephone_number": "804-541-0918",
            "fax_number": "804-541-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N 4TH AVE",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238602503",
            "telephone_number": "804-541-0918",
            "fax_number": "804-541-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODURU",
        "first_name": "BANERJE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "01010300086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007140436",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica D Keller, DDS
• Tierra Lashonda Kelly, MSN. FNP-C
• Key to Care Mental Health and Wellness LLC
• Mansoor A Khan, MD
• Mya Spencer King, D.P.T.
• Kan W Kong, RPH
• KRC Hopkins LLC (Right at Home Prince George)
• Toan La, PHARM D
• David Layman, M.D.
• Lebow Eye Associates, P.C.

• Psychiatry Physician in Hopewell, VA
• Providers in Hopewell, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.