Renuka Kandula, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35.074211 Issued in OH

Practice address

100 Jackson Pike
Gallipolis, OH 45631-1560

Phone

(740) 446-5131

Fax

(740) 446-5486

NPI assigned

Jun 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 8

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Fresenius Medical Care Indian Hills, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jackson, OH
  • NPI 1326338872
  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1427095736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5131",
            "fax_number": "740-446-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-446-5131",
            "fax_number": "740-446-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDULA",
        "first_name": "RENUKA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "20268",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.074211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000006517",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCBS",
            "identifier": "001714104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110166885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON MEDICAID",
            "identifier": "000000181874",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH MEDICAID MOLINA",
            "identifier": "2061512",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0081952000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2061512",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE MEDICAID",
            "identifier": "310917085106",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "renuka.kandula.1@17389.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "100 Jackson Pike",
            "city": "Gallipolis",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456311560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robin Jones, CNP
• Bobbi Lynn Jordan, LPTA
• Kimberly Sue Jordan, LDO
• Susheel S Kakde Sr., M.D.
• Pradeep K. Kandula, M.D.
• Olivia Kee
• Kimberly Keene
• Jennifer Ellen Keller
• Kayla Michelle Kelley, APRN.CNP
• Courtney Renee Kemper, CDCA

• Internal Medicine Physician in Gallipolis, OH
• Providers in Gallipolis, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.