Vijaya Madhavi Koduri, MBBS

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

9303A Issued in WY

Practice address

1252 N 22ND St
Laramie, WY 82072-5306

Phone

(307) 745-3704

Fax

(307) 745-7237

NPI assigned

Jun 28, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Vijaya Madhavi Pinnamaneni Former name

Medicare fee-for-service enrollment

Enrolled in WY

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 and National Provider Directory roles.

• Ivinson Memorial Hospital

  • Rural Health Clinic/Center
  • Laramie, WY
  • NPI 1033628599
  Medicare reassignment NPD
• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1366626269
  NPD
• Laramie Pediatrics Internal Medicine

  • Pediatric Adolescent Medicine Physician
  • Laramie, WY
  • NPI 1336215441
  NPD (past)

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1558672253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3046",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827173046",
            "telephone_number": "307-688-2600",
            "fax_number": "307-685-3079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 N 22ND ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725306",
            "telephone_number": "307-745-3704",
            "fax_number": "307-745-7237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 S. Burma Ave.",
            "address_purpose": "LOCATION",
            "city": "Gillette",
            "state": "WY",
            "postal_code": "827163246",
            "country_code": "US",
            "telephone_number": "307-688-3636",
            "fax_number": "307-688-3079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KODURI",
        "first_name": "VIJAYA",
        "middle_name": "MADHAVI",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-28",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WY",
            "license": "9303A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIJAYA",
            "last_name": "PINNAMANENI",
            "middle_name": "MADHAVI",
            "prefix": "DR.",
            "credential": "MBBS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Lyn Knerr, ATC
• Scott Alan Knerr, ATC
• Kayla Knowlton
• Robyn Marie Koch, COTA/L
• Cliff Kodero
• Carla Koegen, MSW
• Anna Kollaja
• Sarah Kooienga, FNP
• Angela Emma Kopriva, ATC
• Raevyn Koster

• Pediatrics Physician in Laramie, WY
• Providers in Laramie, WY by specialty
• Pediatrics Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; 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.