NPIMap

Individual provider Active NPI

Guru Padmakar Medam, MD

  • Family Medicine Physician
  • Hendersonville, TN
National Provider Identifier
1437464336
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
55403 Issued in TN
Practice address
264 New Shackle Island Rd Ste 107
Hendersonville, TN 37075-2481
Phone
(615) 824-4244
Fax
(615) 824-5916
NPI assigned
Aug 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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 MD2013-0703 NM
Family Medicine Physician 207Q00000X 55403 TN Primary

Addresses

Primary practice location

264 New Shackle Island Rd Ste 107
Hendersonville, TN 37075-2481

Mailing address

264 New Shackle Island Rd Ste 107
Hendersonville, TN 37075-2481
Phone (615) 824-4244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20170630000809 TN Practitioner - Family Practice 8022246412 Reassigns benefits to 1 organization

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

Practice addresses (Care Compare)

264 New Shackle Island Rd
Suite 107
Hendersonville, TN 37075-2480
Phone (615) 824-4244

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.12 of 100Reported as group
Quality
100
Improvement activities
40
Cost
70.41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55403TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NHC Healthcare-Hendersonville LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: guru.medam@cfptn.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/GFDCBA

Organizations & group practices 2

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 6

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": "1281916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1437464336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 107",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752481",
            "telephone_number": "615-824-4244",
            "fax_number": "615-824-5916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 107",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752481",
            "telephone_number": "615-824-4244",
            "fax_number": "615-824-5916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDAM",
        "first_name": "GURU",
        "middle_name": "PADMAKAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-16",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2013-0703",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "55403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

Verify at the official NPI Registry.