Active NPI
Bhavani Vaddey, M.D.
- Family Medicine Physician
- Cumberland, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- D0074019
- Practice address
- 1050 W Industrial Blvd
South Cumberland Market PLC Primary Care
Cumberland, MD 21502-4331 - Phone
- (240) 964-4000
- NPI assigned
- May 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2013020358 | MO | |
| Family Medicine Physician | 207Q00000X | D0074019 | MD | Primary |
| Family Medicine Physician | 207Q00000X | MT195174 | PA |
Addresses
Primary practice location
1050 W Industrial Blvd
South Cumberland Market PLC Primary Care
Cumberland, MD 21502-4331
Mailing address
12500 Willowbrook Rd
Cumberland, MD 21502-6393
Phone (240) 964-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 334-4822
2432 E Main St
Suite B
Jackson, MO 63755-2664
Phone (573) 755-2305
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0074019 | MD | MD | Family Medicine Physician |
| MT195174 | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Missouri Hospital Physicians, LLC | Family Medicine | Current | Accepting new patients |
| Upmc Western Maryland Health Services, LLC | Past | Accepting new patients |
Locations
1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Cape Girardeau, MO
- NPI 1558311522
-
- Internal Medicine Physician
- Cumberland, MD
- NPI 1134844764
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Cape Girardeau, MO
- NPI 1811006661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1336374255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12500 WILLOWBROOK RD",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215026393",
"telephone_number": "240-964-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W INDUSTRIAL BLVD",
"address_2": "SOUTH CUMBERLAND MARKET PLC PRIMARY CARE",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215024331",
"telephone_number": "240-964-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VADDEY",
"first_name": "BHAVANI",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-21",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2013020358",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "D0074019",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MT195174",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Cumberland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; 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.