Amaresh Vydyanathan, MD, MS

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

036124700 Issued in IL

Practice address

1015 S Mercer Ave
Bloomington, IL 61701-7107

Phone

(309) 662-4321

Fax

(309) 661-4532

NPI assigned

Mar 8, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY, PA, TN, GA, NC5 enrollments

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 5

Specialty

AnesthesiologyAlso: Pain Management

Education

Pennsylvania State University College of Medicine, 2004

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Montefiore Medical Center Hospital, Bronx, NY, CCN 330059

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: avydyana@montefioredirect.com

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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment Care Compare group NPD
• Relief Medical Group PA

  • Pain Medicine Physician
  • New York, NY
  • NPI 1801541149

  GA, NC, PA, TN

  Medicare reassignment
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Millennium Pain Center LLC

  • Pain Clinic/Center
  • Bloomington, IL
  • NPI 1225196488
  NPD (past)
• New York Westchester SQ Med Ctr

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1851340608
  NPD (past)
• Openloop Healthcare Partners California PC

  • General Practice Physician
  • Palm Desert, CA
  • NPI 1659042331
  NPD (past)
• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Montefiore Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1952476988
  Care Compare affiliation

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

{
    "created_epoch": "1204934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1336319094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-662-4321",
            "fax_number": "309-661-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-662-4321",
            "fax_number": "309-661-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VYDYANATHAN",
        "first_name": "AMARESH",
        "name_prefix": "Dr.",
        "credential": "MD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-08",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "57.009044",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036124700",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036124700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036124700",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine A Vo, PHARMD.
• Gabriela Vo, LCPC
• Victoria C Voegel, PA-C
• Beth Anne Vogel, LCSW
• Nicholas Ray Von Holten, PA-C
• William Claude Wagner, DDS
• Amanda Wait, B.A.
• Wal-Mart Stores, Inc
• Jennifer Walbridge, LCSW
• Walgreen Co

• Interventional Pain Medicine Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Interventional Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.