NPIMap

Individual provider Active NPI

Mallareddy Maddula, M.D.

  • Nephrology Physician
  • Stockton, CA
National Provider Identifier
1487762647
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A108120 Issued in CA
Practice address
1801 E March LN
Suite B265
Stockton, CA 95210-6629
Phone
(209) 546-1868
Fax
(209) 461-6505
NPI assigned
Aug 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME96158 FL
Nephrology Physician 207RN0300X A108120 CA Primary

Addresses

Primary practice location

1801 E March LN
Suite B265
Stockton, CA 95210-6629

Mailing address

1801 E March LN
Suite B265
Stockton, CA 95210-6629
Phone (209) 546-1868

Other identifiers 2

IdentifierTypeStateIssuer
A108120OtherCASTATE LICENSE
CB971ZOtherCAMEDICARE

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
I20090825000290 CA Practitioner - NephrologyPractitioner - Internal Medicine 6002807336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
San Joaquin Kidney Clinic, IncGroup PAC ID 8527009158, 8 clinicians

Practice addresses (Care Compare)

1801 E March LN
Suite B265
Stockton, CA 95210-6655
Phone (209) 546-1868

801 S Ham LN
Suite J
Lodi, CA 95242-7502
Phone (209) 369-7336

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A108120CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Joaquin Kidney Clinic, Inc CurrentSince Nov 1, 2015 Accepting new patients
East Coast Nephrology Associates LLC Nephrology PastSince Jan 1, 2003 Accepting new patients
Quantum Healthcare Medical Associates Inc. Past Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Brookdale Hospital Medical Center Past Accepting new patients
Daytona Beach Nephrology LLC Nephrology Past Accepting new patients
Southeast Volusia Medical Services Inc Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Dameron Hospital Association Past Accepting new patients
County of San Joaquin Past Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients

Locations

801 S Ham Ln
Ste J
Lodi, CA 95242
Phone (209) 369-7336

900 S Fairmont Ave
Ste C
Lodi, CA 95240
Phone (209) 334-9911

1801 E March Ln
Ste B265
Stockton, CA 95210
Phone (209) 369-7336

1610 N El Dorado St
Ste 16
Stockton, CA 95204
Phone (209) 546-1868

1530 Bessie Ave
Ste 107
Tracy, CA 95376
Phone (209) 834-1443

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mmaddula37059@hisp.ehr.sutterhealth.org
  • FHIR API: https://api.platform.athenahealth.com/20431/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/GHAFAD

Organizations & group practices 12

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 11

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1487762647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN",
            "address_2": "SUITE B265",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN",
            "address_2": "SUITE B265",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-546-1868",
            "fax_number": "209-461-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDULA",
        "first_name": "MALLAREDDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME96158",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A108120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A108120",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB971Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.