Madhuri P Basavaraju, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

062947 Issued in GA

Practice address

3650 Steve Reynolds Boulevard
Kaiser Permanente Gwinnett Medical Office
Duluth, GA 30096

Phone

(770) 931-6010

NPI assigned

Jan 30, 2008

Last updated

Jan 28, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Madhuri Putcha Former name

Medicare fee-for-service enrollment

Enrolled in GA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264636800000",
    "number": "1497932685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 STEVE REYNOLDS BOULEVARD",
            "address_2": "KAISER PERMANENTE GWINNETT MEDICAL OFFICE",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "770-931-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASAVARAJU",
        "first_name": "MADHURI",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-30",
        "last_updated": "2010-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "002102",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "062947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADHURI",
            "last_name": "PUTCHA",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Purnima Bansal, M.D.
• Erjia Bao, MD
• Margaret Barnard, RBT
• Sara Barr, PA
• Kimberley Yatzary Barrera
• Cheryl A Basden, DO
• Jennifer Michelle Bastecki, FNP-C
• Maria Batlle, MD
• Robert Erich Bauman, OD
• Be the Light Chiropractic (Be The Light Body and Spine)

• Pediatrics Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; 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.