NPIMap

Individual provider Active NPI

Shravan Kumar Reddy Gangula, M.D

  • Family Medicine Physician
  • Coffeyville, KS
National Provider Identifier
1437463593
Registry record updated Dec 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0436385 Issued in KS
Practice address
1400 W 4TH St
Coffeyville, KS 67337-3306
Phone
(620) 688-6566
Fax
(620) 688-6577
NPI assigned
Jul 31, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 27717 OK
Family Medicine Physician 207Q00000X 0436385 KS Primary

Addresses

Primary practice location

1400 W 4TH St
Coffeyville, KS 67337-3306

Mailing address

8337 E 81St St Apt 1237
Tulsa, OK 74133-8088
Phone (615) 415-5392

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130925000251 KS Practitioner - Family Practice 4587808944 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coffeyville Regional Medical Center, Inc.Group PAC ID 9032108865, 22 clinicians

Practice addresses (Care Compare)

1400 W 4TH St
Coffeyville, KS 67337-3306
Phone 62025112001147

Hospital & facility affiliations

  • Angels Care Home Health Home health agency, Chanute, KS, CCN 178060
  • Home Town Home Health Home health agency, Independence, KS, CCN 177100
  • Coffeyville Regional Medical Center, Inc Hospital, Coffeyville, KS, CCN 171387
  • Fredonia Regional Hospital Hospital, Fredonia, KS, CCN 171374
  • Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018
  • Medicalodges Coffeyville on Midland Nursing home, Coffeyville, KS, CCN 175290
  • Coffeyville Regional Medical Center, Inc Nursing home, CCN 17Z387

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
69.28
Promoting interoperability
100
Improvement activities
40
Cost
56.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0436385KSMDFamily Medicine Physician
27717OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coffeyville Regional Medical Center, Inc. CurrentSince Jul 2, 2013 Accepting new patients
Coffeyville Regional Medical Center Inc CurrentSince Jul 2, 2013 Accepting new patients
ML-Op Coffeyville LLC Past Accepting new patients
Coffeyville Regional Medical Center Inc Family Medicine Past Accepting new patients

Locations

1400 W 4th St
#100
Coffeyville, KS 67337
Phone (620) 688-6566

1400 W 4th St
Coffeyville, KS 67337
Phone (620) 251-1200

122 W Myrtle St
Independence, KS 67301
Phone (620) 577-4062

Interoperability endpoints

  • Direct secure messaging: sgangula@direct.crmcinc.org
  • Direct secure messaging: shravan.gangula@direct.stjohnhealthsystem.com

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1280534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513296000000",
    "number": "1437463593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8337 E 81ST ST APT 1237",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741338088",
            "telephone_number": "615-415-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W 4TH ST",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673373306",
            "telephone_number": "620-688-6566",
            "fax_number": "620-688-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGULA",
        "first_name": "SHRAVAN",
        "middle_name": "KUMAR REDDY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-31",
        "last_updated": "2017-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "27717",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0436385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coffeyville, KS

Sources for this page

Verify at the official NPI Registry.