Individual provider Active NPI

Pothu Raju Nagabhyru, MD

  • Internal Medicine Physician
  • Silver Spring, MD
National Provider Identifier
1598748824
Registry record updated Jun 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0063639 Issued in MD
Practice address
1500 Forest Glen Rd
Kaiser Permanente Office
Silver Spring, MD 20910-1483
Phone
(301) 754-7126
Fax
(301) 754-7127
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0063639 MD Primary

Addresses

Primary practice location

1500 Forest Glen Rd
Kaiser Permanente Office
Silver Spring, MD 20910-1483

Mailing address

2101 E Jefferson St
Kaiser Permenante Medicare Enrollment
Rockville, MD 20852-4908
Phone (301) 816-2424

Electronic endpoints 2

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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

Enrollment IDStateProvider typePAC IDDetails
I20070305000492 DC Practitioner - Internal Medicine 4880615640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians

Practice addresses (Care Compare)

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

Hospital & facility affiliations

  • Holy Cross Hospital Hospital, Silver Spring, MD, CCN 210004

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0063639MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 2, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 2, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Internal Medicine Current Accepting new patients
Inpatient Specialists PA Internal Medicine Past Accepting new patients
Holy Cross Health, Inc Past Accepting new patients
Premier Physician Group, LLC Internal Medicine Past Accepting new patients
Harbor Hospital Past Accepting new patients
Medstar Harbor Hospital Physicians LLC Past Accepting new patients
Baltimore Washington Medical Center Inc. Internal Medicine Past Accepting new patients
Capital Internal Medicine,LLC Past Accepting new patients

Locations

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

2101 E Jefferson St
Ste 6
Rockville, MD 20852

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

Organizations & group practices 10

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 2

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": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1598748824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "address_2": "KAISER PERMENANTE MEDICARE ENROLLMENT",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "301-816-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FOREST GLEN RD",
            "address_2": "KAISER PERMANENTE OFFICE",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209101483",
            "telephone_number": "301-754-7126",
            "fax_number": "301-754-7127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGABHYRU",
        "first_name": "POTHU RAJU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0063639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "careequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1500 Forest Glen Rd",
            "address_2": "Kaiser Permanente Office",
            "city": "Silver Spring",
            "state": "MD",
            "country_code": "US",
            "postal_code": "209101483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "careequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1500 Forest Glen Rd",
            "address_2": "Kaiser Permanente Office",
            "city": "Silver Spring",
            "state": "MD",
            "country_code": "US",
            "postal_code": "209101483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

Verify at the official NPI Registry.