NPIMap

Individual provider Active NPI

Krishnamohan R Baddigam, MD

  • Pain Medicine (Anesthesiology) Physician
  • Charlotte, NC
National Provider Identifier
1467558577
Registry record updated Jun 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
2009-01794 Issued in NC
Practice address
200 Providence Rd
Suite 101
Charlotte, NC 28207-1407
Phone
(704) 749-5800
Fax
(704) 749-5819
NPI assigned
Sep 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2009-01794 NC
Pain Medicine (Anesthesiology) Physician 207LP2900X 2009-01794 NC Primary
Pain Medicine Physician 208VP0000X 2009-01794 NC

Addresses

Primary practice location

200 Providence Rd
Suite 101
Charlotte, NC 28207-1407

Mailing address

200 Providence Rd
Suite 101
Charlotte, NC 28207-1407
Phone (704) 749-5800

Other identifiers 1

IdentifierTypeStateIssuer
5913791MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20091217000533 NC Practitioner - AnesthesiologyPractitioner - Interventional Pain ManagementPractitioner - Pain Management 1759307358 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management, Pain Management
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anesthesiology Associates PAGroup PAC ID 3971566761, 218 clinicians

Practice addresses (Care Compare)

3735 Glenlake Dr
Suite 250
Charlotte, NC 28208-6866
Phone (704) 749-5800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009-01794NCMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Jun 1, 2013 Accepting new patients
Pain Clinic of Northwestern Wisconsin SC Anesthesiology Past Accepting new patients
Carolina Bone & Joint PA Pain Medicine Past Accepting new patients
Carolina Bone & Joint PA Pain Medicine Past Accepting new patients

Locations

200 Providence Rd
Ste 101
Charlotte, NC 28207

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

3735 Glenlake Dr
Ste 250
Charlotte, NC 28208
Phone (704) 749-5801

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

Organizations & group practices 4

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 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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371427200000",
    "number": "1467558577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PROVIDENCE RD",
            "address_2": "SUITE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071407",
            "telephone_number": "704-749-5800",
            "fax_number": "704-749-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PROVIDENCE RD",
            "address_2": "SUITE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071407",
            "telephone_number": "704-749-5800",
            "fax_number": "704-749-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADDIGAM",
        "first_name": "KRISHNAMOHAN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2013-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2009-01794",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NC",
            "license": "2009-01794",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NC",
            "license": "2009-01794",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913791",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.