NPIMap

Individual provider Active NPI

Prodyut K Poddar

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Woburn, MA
National Provider Identifier
1437156395
Registry record updated Dec 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
50729 Issued in MA
Practice address
800 W. Cummings Park
Suite 4700
Woburn, MA 01801-6372
Phone
(781) 932-6487
Fax
(781) 932-6486
NPI assigned
Jul 6, 2005
Last updated
Dec 6, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 50729 MA Primary

Addresses

Primary practice location

800 W. Cummings Park
Suite 4700
Woburn, MA 01801-6372

Mailing address

340 Main Street
Suite 670
Worcester, MA 01608-1604
Phone (508) 754-3566

Other identifiers 1

IdentifierTypeStateIssuer
2076551MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Cardio Thoracic Associates, Inc. Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients
Cardio Thoracic Associates Inc Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323129600000",
    "number": "1437156395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MAIN STREET",
            "address_2": "SUITE 670",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081604",
            "telephone_number": "508-754-3566",
            "fax_number": "508-438-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W. CUMMINGS PARK",
            "address_2": "SUITE 4700",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018016372",
            "telephone_number": "781-932-6487",
            "fax_number": "781-932-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODDAR",
        "first_name": "PRODYUT",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2011-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MA",
            "license": "50729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2076551",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; 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.