Ghazala Quddus Roopani, MD

Key facts

NPI

1528026408

Entity type

Individual (NPI type 1)

Primary specialty

Nephrology Physician 207RN0300X

License

16972 (WV)

Practice address

167 Stollings Ave
Suite B
Logan, WV 25601-4010

Phone

(304) 752-8800

Fax

(304) 752-9015

NPI assigned

May 2, 2006

Sex

Female

Sole proprietor

No

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 and National Provider Directory roles.

• Ghazala Quddus, M.D., Inc. Nephrology Physician · Logan, WV · NPI 1184658007
  NPD (past) NEPHROLOGY
• Baptist Health Deaconess Madisonville Inc Community/Retail Pharmacy · Madisonville, KY · NPI 1225347719
  NPD (past)
• Pikeville Medical Center Inc Sleep Disorder Diagnostic Clinic/Center · Whitesburg, KY · NPI 1871575498
  NPD (past)
• Total Renal Care Inc End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lake City, SC · NPI 1598204802
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

Other names

• Ghazala Quddus Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 19, 2022.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1528026408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 STOLLINGS AVE",
            "address_2": "SUITE B",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014010",
            "telephone_number": "304-752-8800",
            "fax_number": "304-752-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 STOLLINGS AVE",
            "address_2": "SUITE B",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014010",
            "telephone_number": "304-752-8800",
            "fax_number": "304-752-9015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Bypass Rd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "415011689",
            "country_code": "US",
            "telephone_number": "606-430-2208",
            "fax_number": "606-218-7508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17000 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708163246",
            "country_code": "US",
            "telephone_number": "225-755-4950",
            "fax_number": "225-755-4807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROOPANI",
        "first_name": "GHAZALA",
        "middle_name": "QUDDUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "KY",
            "license": "29243",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "334317",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WV",
            "license": "16972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64698947",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074880003",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007488000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180438000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GHAZALA",
            "last_name": "QUDDUS",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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All providers in Logan, WV · Nephrology Physician in West Virginia