Individual provider Active NPI

Bhaskar Gundabolu, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Toledo, OH
National Provider Identifier
1346458767
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
35088652 Issued in OH
Practice address
2100 W Central Ave
Suite 100
Toledo, OH 43606-3834
Phone
(419) 537-5111
Fax
(419) 537-5131
NPI assigned
May 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 35088652 OH Primary

Addresses

Primary practice location

2100 W Central Ave
Suite 100
Toledo, OH 43606-3834

Mailing address

2100 W Central Ave
Suite 100
Toledo, OH 43606-3834
Phone (419) 537-5111

Other identifiers 6

IdentifierTypeStateIssuer
9567063OtherOHAETNA
6870OtherOHPARAMOUNT
2831243MedicaidOH
66501560001OtherOHMEDICAL MUTUAL
751132OtherOHBUCKEYE
000000541140OtherOHANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bgundabolu14030@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20071031000003 OH Practitioner - EndocrinologyPractitioner - Internal Medicine 8921195496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

2100 W Central Ave
Toledo, OH 43606-3800
Phone (419) 537-5111

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Bay Park Community Hospital Hospital, Oregon, OH, CCN 360259
  • Promedica Defiance Regional Hospital Hospital, Defiance, OH, CCN 361328
  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Memorial Hospital Hospital, Fremont, OH, CCN 360156

Merit-based Incentive Payment System (MIPS)

Final score
81.37 of 100Reported as individual
Quality
74.05
Promoting interoperability
87
Improvement activities
40
Cost
74.69

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bgundabolu14030@direct.promedica.org

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 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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1346458767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W CENTRAL AVE",
            "address_2": "SUITE 100",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063834",
            "telephone_number": "419-537-5111",
            "fax_number": "419-537-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W CENTRAL AVE",
            "address_2": "SUITE 100",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063834",
            "telephone_number": "419-537-5111",
            "fax_number": "419-537-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDABOLU",
        "first_name": "BHASKAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OH",
            "license": "35088652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9567063",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "6870",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2831243",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL  MUTUAL",
            "identifier": "66501560001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "751132",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000541140",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bgundabolu14030@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.