Individual provider Active NPI

Lakshmi Durga Sriramulu, MD

  • Internal Medicine Physician
  • Bloomfield, NJ
National Provider Identifier
1629548672
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2019-01863 Issued in NC
Practice address
40 Conger St Apt 611a
Bloomfield, NJ 07003-3321
Phone
(972) 207-1828
NPI assigned
Dec 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 2019-01863 NC Primary

Addresses

Primary practice location

40 Conger St Apt 611a
Bloomfield, NJ 07003-3321

Mailing address

40 Conger St Apt 611a
Bloomfield, NJ 07003-3321
Phone (972) 207-1828

Other practice location 1

1144 N Road St
Elizabeth City, NC 27909-3473
Phone (252) 335-0531

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20191009003349 NC Practitioner - Internal Medicine 4082945738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 847-1757

Hospital & facility affiliations

  • Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Oct 26, 2022 Accepting new patients

Locations

1144 N Road St
Elizabeth Cty, NC 27909
Phone (252) 384-4610

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Organizations & group practices 1

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": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1629548672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CONGER ST APT 611A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033321",
            "telephone_number": "972-207-1828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CONGER ST APT 611A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033321",
            "telephone_number": "972-207-1828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1144 N Road St",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279093473",
            "country_code": "US",
            "telephone_number": "252-335-0531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SRIRAMULU",
        "first_name": "LAKSHMI DURGA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-03",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2019-01863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

Verify at the official NPI Registry.