Suresh Babu Kodali, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

24553 Issued in KY

Practice address

708 Westport Rd Ste 103
Elizabethtown, KY 42701-2866

Phone

(270) 766-1234

Fax

(270) 766-1144

NPI assigned

Sep 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Suresh Kodali

  • Marriage & Family Therapist
  • Elizabethtown, KY
  • NPI 1437399037
  NPD (past) Authorized official
• United Healthcare of Hardin, Inc

  • Clinical Social Worker
  • Radcliff, KY
  • NPI 1851500466
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1548352156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 WESTPORT RD STE 103",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012866",
            "telephone_number": "270-766-1234",
            "fax_number": "270-766-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 WESTPORT RD STE 103",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012866",
            "telephone_number": "270-766-1234",
            "fax_number": "270-766-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODALI",
        "first_name": "SURESH",
        "middle_name": "BABU",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "24553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64245533",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• KM Psychiatry
• Christopher G Knight, MD
• Kristina L Knisely, MD
• Tracy Knutson
• Raymond Stephen Kociolek, DC, MS, ATC
• Kelly Kohler, LMT
• Kool Smiles PSC
• Chloe Kramer, MA
• Matthew D Krein, O.D.
• Sarah Gallagher Krein, O.D.

• Psychiatry Physician in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Psychiatry Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.