NPIMap

Individual provider Active NPI

Tatenda Andrew Mudyanadzo, MD

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1366903890
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1366903890 Issued in AL
Practice address
4370 W Main St
Dothan, AL 36305-4000
Phone
(334) 793-5000
Fax
(334) 793-5000
NPI assigned
Mar 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1366903890 AL Primary

Addresses

Primary practice location

4370 W Main St
Dothan, AL 36305-4000

Mailing address

4370 W Main St
Dothan, AL 36305-4000
Phone (334) 793-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221004000192 AL Practitioner - Internal Medicine 8426389693 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flowers HB Medical Services LLCGroup PAC ID 6305290990, 139 clinicians

Practice addresses (Care Compare)

4370 W Main St
Dothan, AL 36305-1056
Phone (334) 793-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
45.86 of 100Reported as group
Quality
6.09
Improvement activities
40
Cost
81.25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1366903890ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Flowers HB Medical Services LLC CurrentSince Oct 7, 2023 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Triad of Alabama LLC Past Accepting new patients

Locations

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

Organizations & group practices 3

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 8

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": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1366903890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4370 W MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054000",
            "telephone_number": "334-793-5000",
            "fax_number": "334-793-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 W MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054000",
            "telephone_number": "334-793-5000",
            "fax_number": "334-793-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDYANADZO",
        "first_name": "TATENDA",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "1366903890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.