NPIMap

Individual provider Active NPI

Manith Bondugula

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1588168157
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
T4126 Issued in TX
Practice address
1001 12TH Ave Ste 102
Fort Worth, TX 76104-3926
Phone
(817) 725-7880
Fax
(817) 447-7110
NPI assigned
Mar 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 47326 TX
Internal Medicine Physician 207R00000X T4126 TX Primary

Addresses

Primary practice location

1001 12TH Ave Ste 102
Fort Worth, TX 76104-3926

Mailing address

1000 Cannon St.
Fort Worth, TX 76104
Phone (817) 725-7900

Other practice location 1

265 SE John Jones Dr Ste 102
Burleson, TX 76028-8356
Phone (682) 990-0747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210625000312 TX Practitioner - Internal Medicine 8224385653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PPG Health PAGroup PAC ID 7113904657, 32 clinicians

Practice addresses (Care Compare)

1001 12TH Ave
Fort Worth, TX 76104-3926
Phone (817) 725-7880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T4126TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PPG Health, PA Internal Medicine CurrentSince Jul 15, 2021 Accepting new patients
Columbia North Hills Hospital Subsidiary LP Past Accepting new patients
Ai Interventional LLC Internal Medicine PastSince Oct 22, 2025 Accepting new patients
Columbia Plaza Medical Center of Fort Worth Subsidiary LP Past Accepting new patients

Locations

3301 Matlock Rd
Arlington, TX 76015
Phone (682) 509-6200

265 SE John Jones Dr
Ste 102
Burleson, TX 76028
Phone (817) 284-9225

1001 12th Ave
Ste 102
Fort Worth, TX 76104
Phone (817) 725-7880

909 9th Ave
Ste 400
Fort Worth, TX 76104
Phone (817) 338-9291

3848 North Tarrant Pkwy
Ste 160
Fort Worth, TX 76244
Phone (817) 725-7880

1000 W Cannon St
Ft Worth, TX 76104
Phone (817) 725-7900

9947 N MacArthur Blvd
Ste 150
Irving, TX 75063
Phone (817) 406-2064

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.

Hospital & facility affiliations 5

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": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1588168157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CANNON ST.",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-725-7900",
            "fax_number": "682-207-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE STE 102",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "817-725-7880",
            "fax_number": "817-447-7110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "265 SE John Jones Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Burleson",
            "state": "TX",
            "postal_code": "760288356",
            "country_code": "US",
            "telephone_number": "682-990-0747",
            "fax_number": "817-447-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONDUGULA",
        "first_name": "MANITH",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-20",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "47326",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "T4126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.