Jagannadharao Brahmamdam, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

03606004 Issued in IL

Practice address

812 N Logan Ave
Danville, IL 61832-3752

Phone

(217) 431-8413

Fax

(217) 431-1397

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• East Central Illinois Radiology Associates, LLC

  • Diagnostic Radiology Physician
  • Danville, IL
  • NPI 1912277443
  Medicare reassignment NPD
• United Radiology Service

  • Diagnostic Radiology Physician
  • Danville, IL
  • NPI 1255356820
  NPD (past) Authorized official

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1457386922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618323752",
            "telephone_number": "217-431-8413",
            "fax_number": "217-431-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618323752",
            "telephone_number": "217-431-8413",
            "fax_number": "217-431-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAHMAMDAM",
        "first_name": "JAGANNADHARAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "03606004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360600041",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200108180",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary W Bowlin, DC
• Bowman Estates
• Amy Boyer
• Elise Marie Boyer, MS, RD, LDN
• Carol Bradford
• Puneet Singh Braich, M.D., M.P.H.
• Suzanne Brandon, MSW, ACSW, LCSW
• Christina Brashear, BS, MHP
• Leo V Bratland, R PH
• Bratland's Prescription Shop Inc

• Diagnostic Radiology Physician in Danville, IL
• Providers in Danville, 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 Oct 12, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.