Bhasker Rao Koppula, M.D

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036166661 Issued in IL

Practice address

4201 W Medical Center Dr
McHenry, IL 60050-8409

Phone

(815) 334-5566

Fax

(815) 759-4008

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT, IL, TX, IA4 enrollments

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 4

Specialty

Nuclear Medicine

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

American Radiology Consultants PLLCGroup PAC ID 6709868409, 120 clinicians

Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110
• Saint James Hospital Hospital, Pontiac, IL, CCN 140161
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 66)

Interoperability endpoints

• Direct secure messaging: bkoppula37288@direct.med.utah.edu

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.

• Central Illinois Radiological Associates, LTD.

  • Diagnostic Radiology Physician
  • Peoria, IL
  • NPI 1538192828

  UT

  Medicare reassignment Care Compare group NPD
• American Radiology Consultants PLLC

  • Diagnostic Radiology Physician
  • Dallas, TX
  • NPI 1669425195

  UT

  Medicare reassignment Care Compare group NPD
• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314

  Diagnostic Radiology

  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527

  TX

  Medicare reassignment NPD
• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Medicare reassignment NPD
• Maryland Imaging Network PC

  • Diagnostic Radiology Physician
  • Prince Frederick, MD
  • NPI 1487296471

  UT

  Medicare reassignment NPD
• Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance

  • Radiology Clinic/Center
  • Tacoma, WA
  • NPI 1083802946

  TX

  Medicare reassignment NPD
• Tra-Minw P S

  • Radiology Clinic/Center
  • Tacoma, WA
  • NPI 1396814166

  TX

  Medicare reassignment NPD
• Union Avenue Open MRI LLC

  • Radiology Clinic/Center
  • Tacoma, WA
  • NPI 1568531242

  TX

  Medicare reassignment NPD
• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Akumin Imaging Texas LLC

  • Radiology Clinic/Center
  • El Paso, TX
  • NPI 1235771205
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ottawa Regional Hospital & Healthcare Center

  • General Acute Care Hospital
  • Peru, IL
  • NPI 1588713440
  Care Compare affiliation
• Saint James Hospital

  • General Acute Care Hospital
  • Pontiac, IL
  • NPI 1407808090
  Care Compare affiliation

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1417033267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF RADIOLOGY UNIVERSITY OF UTAH",
            "address_2": "30 NORTH 1900 EAST, #1A071",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841322140",
            "telephone_number": "801-581-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 W MEDICAL CENTER DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508409",
            "telephone_number": "815-334-5566",
            "fax_number": "815-759-4008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Department Of Radiology University Of Utah",
            "address_2": "30 North 1900 East, #1A071",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841322140",
            "country_code": "US",
            "telephone_number": "801-581-7553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1304 Fawcett Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984021900",
            "country_code": "US",
            "telephone_number": "253-761-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOPPULA",
        "first_name": "BHASKER RAO",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036166661",
            "primary": true
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "UT",
            "license": "7682213-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60120325",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "7682213-1205",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "339350",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8443277",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bkoppula37288@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Kolthoff
• Madeline Komistra
• Jacqueline Nuerteki Kontoh
• Dileep Koottanal, PHARM.D.
• Faye Maria Kopplin, N.P
• Ann Lull Korpan, MST SLPL
• Sarah Elizabeth Kotz
• Julia Ann Kovacs
• Allison Kranich, MS
• Anne Krause

• Diagnostic Radiology Physician in McHenry, IL
• Providers in McHenry, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.