Mangadhara Rao Madineedi, MD, MSA, FACP

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

79686 Issued in MA

Practice address

940 Belmont St
Geriatrics & Extended Care Service Line (181)
Brockton, MA 02301-5596

Phone

(774) 826-1860

Fax

(774) 826-2643

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1376552901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 BELMONT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015596",
            "telephone_number": "508-583-4500",
            "fax_number": "774-826-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 BELMONT ST",
            "address_2": "GERIATRICS & EXTENDED CARE SERVICE LINE (181)",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015596",
            "telephone_number": "774-826-1860",
            "fax_number": "774-826-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADINEEDI",
        "first_name": "MANGADHARA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "MD, MSA, FACP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-03-07",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "79686",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "79686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3136809",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CONTROLLED SUBSTANC",
            "identifier": "MM0137186AS",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A. Macneil, LMHC
• Jessie H Macvicar, MD
• Lilliana Maday
• Courtney Madden, AGNP-C
• Shelina Maddrey
• Clarisse Flore Ngankam Madjeu, RN,BSN
• Darlene Madore, CPNP-PC, RN
• Anna Liza Madrigal
• Chidozie Madu
• Tayla Marie Magerman, MS, RD, LDN

• Internal Medicine Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.