NPIMap

Individual provider Active NPI

Pridvi Gautham Kandagatla, M.D.

  • Colon & Rectal Surgery Physician
  • Saint Paul, MN
National Provider Identifier
1346668555
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
71756 Issued in MN
Practice address
1983 Sloan PL Ste 11
Saint Paul, MN 55117-2004
Phone
(651) 312-1620
Fax
(651) 312-1570
NPI assigned
Apr 3, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 71756 MN Primary

Addresses

Primary practice location

1983 Sloan PL Ste 11
Saint Paul, MN 55117-2004

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220806000730 MN Practitioner - Colorectal Surgery (Proctology) 4981829850 Reassigns benefits to 3 organizations
I20251120000485 WI Practitioner - Colorectal Surgery (Proctology) 4981829850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Wayne State University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minnesota Oncology Hematology PAGroup PAC ID 6709799752, 131 clinicians
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1580 Beam Ave
Maplewood, MN 55109-1127
Phone (651) 779-7978

2651 Hillcrest Dr
Suite 105
Hudson, WI 54016-9919
Phone (715) 531-6800

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

  • Allina United Hospital Hospital, Saint Paul, MN, CCN 240038
  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207
  • M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy13
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Jul 1, 2025 Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2024 Accepting new patients
Minnesota Oncology Hematology PA CurrentSince Oct 1, 2025 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2024 Accepting new patients
Minnesota Oncology Hematology, PA CurrentSince Oct 1, 2025 Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2025 Accepting new patients
Fairview Health Services Current Accepting new patients
Minnesota Oncology Hematology, PA CurrentSince Nov 1, 2025 Accepting new patients
Minnesota Oncology Hematology, PA Past Accepting new patients
Minnesota Oncology Hematology, PA PastSince Jan 12, 2020 Accepting new patients
Allina Health System Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

1175 Paysphere Cir
Chicago, IL 60674

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

2945 Hazelwood St
Ste 340
Maplewood, MN 55109
Phone (651) 312-1620

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

2550 University Ave W
Ste 110N
Saint Paul, MN 55114
Phone (651) 602-5309

310 Smith Ave N
Ste 100
Saint Paul, MN 55102
Phone (651) 251-5500

2651 Hillcrest Dr
Ste 105
Hudson, WI 54016
Phone (715) 280-9151

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1346668555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600",
            "fax_number": "952-512-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1983 SLOAN PL STE 11",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551172004",
            "telephone_number": "651-312-1620",
            "fax_number": "651-312-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDAGATLA",
        "first_name": "PRIDVI",
        "middle_name": "GAUTHAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MN",
            "license": "71756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.