NPIMap

Individual provider Active NPI

Vijaya Dudyala, M.D

  • Internal Medicine Physician
  • San Jose, CA
National Provider Identifier
1477522589
Registry record updated Nov 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A79466 Issued in CA
Practice address
828 S Winchester Blvd
San Jose, CA 95128-2930
Phone
(408) 866-4000
Fax
(408) 866-3999
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A79466 CA Primary

Addresses

Primary practice location

828 S Winchester Blvd
San Jose, CA 95128-2930

Mailing address

828 S Winchester Blvd
San Jose, CA 95128-2930
Phone (408) 866-4000

Other identifiers 1

IdentifierTypeStateIssuer
00A794660MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040917000843 CA Practitioner - Internal Medicine 7113995127 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
El Camino Health Medical Network LLCGroup PAC ID 6103115183, 202 clinicians

Practice addresses (Care Compare)

828 S Winchester Blvd
San Jose, CA 95128-2930
Phone (408) 871-3400

Hospital & facility affiliations

  • El Camino Health Hospital, Mountain View, CA, CCN 050308
  • Good Samaritan Hospital Hospital, San Jose, CA, CCN 050380

Merit-based Incentive Payment System (MIPS)

Final score
89.25 of 100Reported as subgroup
Quality
87.84
Promoting interoperability
100
Improvement activities
40
Cost
76.33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A79466CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Township Medical Foundation Internal Medicine CurrentSince May 17, 2016 Accepting new patients
El Camino Health Medical Network, LLC CurrentSince Mar 16, 2020 Accepting new patients
Washington Township Medical Foundation CurrentSince May 17, 2016 Accepting new patients
El Camino Health Medical Group CurrentSince Feb 1, 2018 Accepting new patients
El Camino Hospital Past Accepting new patients
Washington Township Hospital District Past Accepting new patients
El Camino Hospital Past Accepting new patients

Locations

39500 Fremont Blvd
Ste 100
Fremont, CA 94538
Phone (510) 248-1800

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500

828 S Winchester Blvd
San Jose, CA 95128
Phone (408) 866-4000

33077 Alvarado Niles Rd
Union City, CA 94587
Phone (510) 248-1500

Interoperability endpoints

  • Direct secure messaging: vdudyala45478@icare.elcaminohospital.org

Organizations & group practices 7

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 4

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1477522589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 S WINCHESTER BLVD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282930",
            "telephone_number": "408-866-4000",
            "fax_number": "408-866-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 S WINCHESTER BLVD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282930",
            "telephone_number": "408-866-4000",
            "fax_number": "408-866-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDYALA",
        "first_name": "VIJAYA",
        "name_prefix": "Mrs.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A79466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A794660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.