NPIMap

Individual provider Active NPI

Praveen Dandamudi, M.D.

  • Nephrology Physician
  • Nashville, TN
National Provider Identifier
1386820413
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
52782 Issued in TN
Practice address
2201 Murphy Ave Ste 303
Nashville, TN 37203-1895
Phone
(615) 628-8064
Fax
(877) 297-3060
NPI assigned
Jan 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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 125049524 IL
Internal Medicine Physician 207R00000X 52782 TN
Nephrology Physician 207RN0300X 52782 TN Primary

Addresses

Primary practice location

2201 Murphy Ave Ste 303
Nashville, TN 37203-1895

Mailing address

2201 Murphy Ave Ste 303
Nashville, TN 37203-1895
Phone (615) 628-8064

Other identifiers 3

IdentifierTypeStateIssuer
6046839OtherTNBCBS
Q013761MedicaidTN
7100358320MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, CA2 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
I20150806012959 TN Practitioner - NephrologyPractitioner - Internal Medicine 0446311591 Reassigns benefits to 1 organization
I20240124001211 CA Practitioner - Nephrology 0446311591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Kidney Specialists PLCGroup PAC ID 2264671023, 8 clinicians

Practice addresses (Care Compare)

2201 Murphy Ave
Suite 303
Nashville, TN 37203-1895
Phone (615) 628-8064

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125049524ILMDInternal Medicine Physician
52782TNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concertocare Medical Group of California, P.C. Internal Medicine CurrentSince Dec 13, 2023 Accepting new patients
Chicago Heart Rhythm LLC PastSince Mar 5, 2012 Accepting new patients

Locations

7677 Center Ave
Ste 214
Huntington Beach, CA 92647
Phone (310) 433-9507

811 Main St
#7
Kansas City, MO 64105

Interoperability endpoints

  • Direct secure messaging: somatusmedicalgroup.praveendandamudit@157982.advancedmd-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1200614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1386820413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 MURPHY AVE STE 303",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031895",
            "telephone_number": "615-628-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 MURPHY AVE STE 303",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031895",
            "telephone_number": "615-628-8064",
            "fax_number": "877-297-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANDAMUDI",
        "first_name": "PRAVEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-18",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125049524",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "52782",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TN",
            "license": "52782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6046839",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q013761",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100358320",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.