Prasuna Gnana Dubagunta, M.D.
Individual provider Active NPI Internal Medicine Physician · Glencoe, MN
NPI 1376573014 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1376573014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 64422 (MN)
- Practice address
- 1805 Hennepin Ave N
Glencoe, MN 55336-1416 - Phone
- (320) 864-3121
- Fax
- (320) 864-7887
- NPI assigned
- Jul 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 3
Medicare Care Compare profile
- 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 Clinics
Practice addresses (Care Compare)
13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (763) 572-5700
Hospital & facility affiliations
- M Health Fairview Southdale Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.44 of 100
- Quality
- 82.65
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.21
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.35 of 100
- Quality
- 91.74
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.13
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181030000731 | MN | Practitioner - Internal Medicine | 7618930017 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healtheast Medical Research Institute | Current |
Accepting new patients | |
| Fairview Health Services | Internal Medicine | Current |
Accepting new patients |
| Fairview Clinics | Current |
Accepting new patients | |
| Fairview Express Care | Current |
Accepting new patients | |
| Fairview Health Services | Current |
Accepting new patients | |
| Fairview Clinics | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Healtheast Medical Research Institute | Current | Accepting new patients | |
| Healtheast Woodwinds Hospital | Current |
Accepting new patients | |
| Healtheast St. John'S Hospital | Current |
Accepting new patients | |
| Fairview Express Care | Current |
Accepting new patients | |
| Healtheast Medical Research Institute | Internal Medicine | Current |
Accepting new patients |
| Fairview Clinics | Current |
Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Candler Internal Medicine | Internal Medicine | Past | Accepting new patients |
| Mayo Clinic Health System in Waycross, Inc. | 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
717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617
2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838
911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313
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
1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000
69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100
1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100
Interoperability endpoints
- pdubagunta402076@excellian.direct.allina.com
- pdubagunta712537@fairview.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 055401 | GA | |
| Internal Medicine Physician | 207R00000X | 64422 | MN | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208812201 | Medicaid | TX | |
| 8CF471 | Other | TX | BCBS |
Other names
- Dr. Prasuna G Brahmamdam
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pdubagunta402076@excellian.direct.allina.com | Direct |
Other providers in Glencoe, MN
- Damour Counseling PLLC
- Day by Day Recovery Center, LLC
- Patricia Jeanette De Loyal
- Amy Dittmer
- Doctors Inc
- William John Dunbar
- Carol Jo Eggersgluess
- Pamela Jean Ellis
- Abby Marie Evans
- Andrew Cole Fiecke
All providers in Glencoe, MN · Internal Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.