NPIMap

Individual provider Active NPI

Pradeep Chakravarthy Bollu, MD

  • Neurology Physician
  • Columbia, SC
National Provider Identifier
1598094393
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
85697 Issued in SC
Practice address
1333 Taylor St Ste 1C
Columbia, SC 29201-2944
Phone
(803) 254-6391
Fax
(803) 799-0682
NPI assigned
Dec 8, 2009
Last updated
Jul 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 2014021713 MO
Neurology Physician 2084N0400X 85697 SC Primary

Addresses

Primary practice location

1333 Taylor St Ste 1C
Columbia, SC 29201-2944

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, HI, FL, IL4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20210803000067 SC Practitioner - Neurology 1456595263 Reassigns benefits to 1 organization
I20211216002258 HI Practitioner - NeurologyPractitioner - Sleep Medicine 1456595263 Reassigns benefits to 2 organizations
I20230830000992 FL Practitioner - NeurologyPractitioner - Psychiatry 1456595263 Reassigns benefits to 3 organizations
I20231018000141 IL Practitioner - NeuropsychiatryPractitioner - Sleep Medicine 1456595263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeuropsychiatryAlso: Sleep Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
CGH Medical CenterGroup PAC ID 6103723267, 199 clinicians
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

101 E Miller Rd
Sterling, IL 61081-1252
Phone (815) 625-4790

1333 Taylor St
Suite 1C
Columbia, SC 29201-2944
Phone (803) 254-6391

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85697SCMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medlink Management Services Inc CurrentSince Aug 1, 2023 Accepting new patients
Samuel Mahelona Memorial Hospital CurrentSince Apr 1, 2023 Accepting new patients
Samuel Mahelona Memorial Hospital CurrentSince Apr 1, 2023 Accepting new patients
Prisma Health Medical Group-Midlands Neurology CurrentSince Jul 1, 2021 Accepting new patients
Samuel Mahelona Memorial Hospital Current Accepting new patients
CGH Medical Center CurrentSince Sep 1, 2023 Accepting new patients
Kauai Veterans Memorial Hospital Current Accepting new patients
Kauai Veterans Memorial Hospital CurrentSince Oct 1, 2021 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jul 1, 2021 Accepting new patients
CGH Medical Center CurrentSince Sep 1, 2023 Accepting new patients
Medlink Management Services Inc Past Accepting new patients
Ozarks Medical Center Neurology Past Accepting new patients

Locations

575 SE 3rd Ave
Ste 2
Lake Butler, FL 32054
Phone (386) 496-1933

850 E Main St
Lake Butler, FL 32054
Phone (386) 496-1922

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

1301 Taylor St
Ste 7A
Columbia, SC 29201
Phone (803) 254-6391

1333 Taylor St
Ste 1C
Columbia, SC 29201
Phone (803) 254-6391

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Interoperability endpoints

  • Direct secure messaging: pbollu20917@cghmc.direct-ci.com
  • Direct secure messaging: pbollu513885@direct.ghs.myhfn.org

Organizations & group practices 12

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 12

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": "1260230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1598094393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 TAYLOR ST STE 1C",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012944",
            "telephone_number": "803-254-6391",
            "fax_number": "803-799-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLU",
        "first_name": "PRADEEP",
        "middle_name": "CHAKRAVARTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-08",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2014021713",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "85697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.