NPIMap

Individual provider Active NPI

Prasuna Gnana Dubagunta, M.D.

  • Internal Medicine Physician
  • Glencoe, MN
National Provider Identifier
1376573014
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
64422 Issued in MN
Practice address
1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone
(320) 864-3121
Fax
(320) 864-7887
NPI assigned
Jul 4, 2006
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 055401 GA
Internal Medicine Physician 207R00000X 64422 MN Primary
Internal Medicine Physician 207R00000X N1617 TX

Addresses

Primary practice location

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Mailing address

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-3121

Other identifiers 2

IdentifierTypeStateIssuer
8CF471OtherTXBCBS
208812201MedicaidTX

Other names 1

  • Dr. Prasuna G Brahmamdam Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pdubagunta402076@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20181030000731 MN Practitioner - Internal Medicine 7618930017 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Texas Tech University Health Science Center School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (763) 572-5700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
91.74
Promoting interoperability
100
Improvement activities
40
Cost
77.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64422MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Dec 17, 2021 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics Current Accepting new patients
Healtheast Woodwinds Hospital CurrentSince Dec 17, 2021 Accepting new patients
Fairview Clinics CurrentSince Dec 17, 2021 Accepting new patients
Healtheast St. John's Hospital CurrentSince Dec 17, 2021 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Dec 17, 2021 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services CurrentSince Dec 17, 2021 Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 17, 2021 Accepting new patients
Fairview Health Services Internal Medicine CurrentSince Dec 17, 2021 Accepting new patients
Fairview Express Care CurrentSince Dec 17, 2021 Accepting new patients
Fairview Clinics CurrentSince Dec 17, 2021 Accepting new patients
Mayo Clinic Health System in Waycross, Inc. Past Accepting new patients
Candler Internal Medicine Internal Medicine Past Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

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

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

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: pdubagunta402076@excellian.direct.allina.com
  • Direct secure messaging: pdubagunta712537@fairview.direct-ci.com

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 17

Hospital & facility affiliations 3

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1376573014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121",
            "fax_number": "320-864-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBAGUNTA",
        "first_name": "PRASUNA",
        "middle_name": "GNANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "055401",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "64422",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N1617",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8CF471",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208812201",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pdubagunta402076@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1805 Hennepin Ave N",
            "city": "Glencoe",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553361416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PRASUNA",
            "last_name": "BRAHMAMDAM",
            "middle_name": "G",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glencoe, MN

Sources for this page

Verify at the official NPI Registry.