Anurag Gaddam, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

01096395A Issued in IN

Practice address

775 Pole Line Rd W Ste 112
Twin Falls, ID 83301-5819

Phone

(208) 814-8200

Fax

(208) 933-4921

NPI assigned

Apr 30, 2018

Reactivated

Dec 10, 2018

Last updated

Aug 20, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

State licenses

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1558859165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 112",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015819",
            "telephone_number": "208-814-8200",
            "fax_number": "208-933-4921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 N Capitol Ave # E371",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025305",
            "country_code": "US",
            "telephone_number": "317-274-0700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GADDAM",
        "first_name": "ANURAG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "deactivation_date": "2018-12-05",
        "reactivation_date": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IN",
            "license": "01096395A",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "3981209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennie Rebecca Fullmer, LPC
• Shawna Fultz, LMSW
• Chase A Funk, DDS
• Spencer Funk, DO
• G Adrian Dean MD Inc
• Cecil Gailey
• Mildred Azucena Gaitan-Gonzalez, L.C.S.W.
• Dawn Gallagher, M.A.
• Jennifer M Gallardo, PT
• Virginia Gambrel

• Interventional Cardiology Physician in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Interventional Cardiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.