NPIMap

Individual provider Active NPI

Amudhan Jyothidasan, M.D.

  • Interventional Cardiology Physician
  • Fayetteville, NC
National Provider Identifier
1619282365
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
2017-01125 Issued in NC
Practice address
3634 Cape Center Dr
Fayetteville, NC 28304-4406
Phone
(910) 485-6470
NPI assigned
Aug 18, 2010
Last updated
Mar 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 2017-01125 NC Primary
Internal Medicine Physician 207R00000X 245539 MA
Interventional Cardiology Physician 207RI0011X 96109 SC

Addresses

Primary practice location

3634 Cape Center Dr
Fayetteville, NC 28304-4406

Mailing address

3634 Cape Center Dr
Fayetteville, NC 28304-4406
Phone (910) 485-6470

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (774) 442-2173

Other practice location 2

6010 Highway 707 Ste 300
Myrtle Beach, SC 29588-7321
Phone (843) 347-8953

Other practice location 3

2376 Cypress Cir Ste 102
Conway, SC 29526-8964
Phone (843) 347-8953

Other identifiers 1

IdentifierTypeStateIssuer
961093MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20171004001506 NC Practitioner - Cardiovascular Disease (Cardiology) 6608019369 Reassigns benefits to 1 organization
I20260313000806 SC Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6608019369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Fear Cardiology Associates PAGroup PAC ID 3476539883, 11 clinicians

Practice addresses (Care Compare)

3634 Cape Ctr Dr
Fayetteville, NC 28304-4406
Phone (910) 485-6470

3650 Cape Ctr Dr
Fayetteville, NC 28304-2139
Phone (910) 485-6470

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.21 of 100Reported as group
Quality
80.42
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting17
Pacemaker insertion or repair1-10
Varicose vein removal16
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006493GAMDClinical Social Worker
245539MAMDInternal Medicine Physician
2017-01125NCMDInterventional Cardiology Physician
96109SCMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Fear Cardiology Associates PA Cardiovascular Disease CurrentSince Aug 1, 2017 Accepting new patients

Locations

3634 Cape Center Dr
Fayetteville, NC 28304
Phone (910) 485-6470

Interoperability endpoints

  • Direct secure messaging: amudhan.jyothidasan@xcfc.ssdirect.aprima.com

Organizations & group practices 2

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1619282365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3634 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044406",
            "telephone_number": "910-485-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3634 CAPE CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044406",
            "telephone_number": "910-485-6470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "774-442-2173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6010 Highway 707 Ste 300",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295887321",
            "country_code": "US",
            "telephone_number": "843-347-8953",
            "fax_number": "843-347-0226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2376 Cypress Cir Ste 102",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295268964",
            "country_code": "US",
            "telephone_number": "843-347-8953",
            "fax_number": "843-347-0226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JYOTHIDASAN",
        "first_name": "AMUDHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-18",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NC",
            "license": "2017-01125",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "245539",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "SC",
            "license": "96109",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "961093",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.