NPIMap

Individual provider Active NPI

Archana Gundabolu

  • Student in an Organized Health Care Education/Training Program
  • Toledo, OH
National Provider Identifier
1558892406
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2213 Franklin Ave
Mercy Family Care Center
Toledo, OH 43620-1402
Phone
(419) 251-2360
Fax
(419) 251-2393
NPI assigned
Mar 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2213 Franklin Ave
Mercy Family Care Center
Toledo, OH 43620-1402

Mailing address

2213 Cherry St
Mercy St. Vincent Medical Center
Toledo, OH 43608-2603
Phone (419) 251-4554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200901002778 PA Practitioner - Internal Medicine 2668899964 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenixville Clinic Company LLCGroup PAC ID 5799796850, 135 clinicians
Pottstown Clinic Company LLCGroup PAC ID 6406857184, 112 clinicians

Practice addresses (Care Compare)

140 Nutt Rd
Phoenixville, PA 19460-3906
Phone (610) 983-1000

1600 E High St
Pottstown, PA 19464-5093
Phone (610) 327-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.14 of 100Reported as group
Quality
74.13
Promoting interoperability
98
Improvement activities
40
Cost
78.01

Merit-based Incentive Payment System (MIPS)

Final score
84.7 of 100Reported as group
Quality
76.12
Promoting interoperability
99
Improvement activities
40
Cost
73.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tower Health Medical Group CurrentSince Jan 17, 2022 Accepting new patients
Pottstown Clinic Company LLC CurrentSince Sep 14, 2020 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince Sep 14, 2020 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince Sep 14, 2020 Accepting new patients
Tower Health Medical Group CurrentSince Jan 17, 2022 Accepting new patients
Phoenixville Hospital, LLC Past Accepting new patients
Pottstown Hospital, LLC Past Accepting new patients

Locations

140 Nutt Rd
Phoenixville, PA 19460
Phone (610) 983-1000

730 S Hanover St
Pottstown, PA 19465
Phone (610) 323-6835

1600 E High St
Pottstown, PA 19464
Phone (610) 327-7485

201 Reeceville Rd
West Brandywine, PA 19320
Phone (215) 788-2285

420 S 5th Ave
West Reading, PA 19611
Phone (484) 628-3637

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Organizations & group practices 7

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491436800000",
    "number": "1558892406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 CHERRY ST",
            "address_2": "MERCY ST. VINCENT MEDICAL CENTER",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082603",
            "telephone_number": "419-251-4554",
            "fax_number": "419-251-6795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2213 FRANKLIN AVE",
            "address_2": "MERCY FAMILY CARE CENTER",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201402",
            "telephone_number": "419-251-2360",
            "fax_number": "419-251-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDABOLU",
        "first_name": "ARCHANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.