Chethan Ram Mudiyam, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

R77674 Issued in AZ

Practice address

1441 N 12TH St
Phoenix, AZ 85006-2837

Phone

(602) 521-5700

Fax

(602) 521-5701

NPI assigned

Jun 28, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cmudiyam3008597@carolinashealthcaresystem.direct-ci.com

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.

• Banner - University Physician Specialists LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1437529245
  Medicare reassignment NPD
• Atrium Health North Market Network LLC

  • Family Medicine Physician
  • Mooresville, NC
  • NPI 1871112920
  Medicare reassignment NPD
• Banner - University Physician Specialists LLC

  • Multi-Specialty Clinic/Center
  • Maricopa, AZ
  • NPI 1063887727
  NPD
• Banner - University Physician Specialists LLC

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1164255865
  NPD
• Banner Desert Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1720011810
  NPD (past)

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1609361971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062612",
            "telephone_number": "602-839-3827",
            "fax_number": "602-839-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837",
            "telephone_number": "602-521-5700",
            "fax_number": "602-521-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDIYAM",
        "first_name": "CHETHAN",
        "middle_name": "RAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "R77674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samer Mohd Faruq Muala, MD
• Huiam Mubarak, MD
• Diane Neville Much, M.S., R.D.
• Greg P. Muchnij X, CH
• David Elliott Mudge, PA
• Stefan Mudryj, DPM
• Britni Mueller
• Hitomi Mueller, M.ED
• Jeffrey T Mueller, M.D.
• Lauren Mueller

• Obstetrics & Gynecology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Obstetrics & Gynecology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.