Individual provider Active NPI

Bhavani Vaddey, M.D.

  • Family Medicine Physician
  • Cumberland, MD
National Provider Identifier
1336374255
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0074019 Issued in MD
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

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140116001419 MO Practitioner - Emergency Medicine 7517117054 Reassigns benefits to 1 organization

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. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0074019MDMDFamily Medicine Physician
MT195174PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Missouri Hospital Physicians, LLC Family Medicine CurrentSince Oct 12, 2013 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.

Hospital & facility affiliations 1

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": "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

Verify at the official NPI Registry.