NPIMap

Individual provider Active NPI

Madhusudhan P Reddy, MD

  • Diagnostic Radiology Physician
  • Williston, ND
National Provider Identifier
1639389133
Registry record updated Nov 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
11765 Issued in ND
Practice address
1301 15TH Ave. W.
Williston, ND 58801-3821
Phone
(701) 774-7400
Fax
(701) 774-7479
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2012

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 14725R LA
Diagnostic Radiology Physician 2085R0202X 60041527 WA
Diagnostic Radiology Physician 2085R0202X 11765 ND Primary
Diagnostic Radiology Physician 2085R0202X 35.094848 OH

Addresses

Primary practice location

1301 15TH Ave. W.
Williston, ND 58801-3821

Mailing address

3614 142 Place NE
Bellevue, WA 98007-3231
Phone (318) 675-5000

Other identifiers 1

IdentifierTypeStateIssuer
15376MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110131000867 ND Practitioner - Diagnostic Radiology 1052472420 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Charity AssociationGroup PAC ID 2264341031, shared by 6 NPIs, 168 clinicians

Practice addresses (Care Compare)

2422 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 252-1050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14725RLAMDDiagnostic Radiology Physician
35.094848OHMDDiagnostic Radiology Physician
60041527WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Charity Association Current Accepting new patients
Mercy Home Care CurrentSince Jan 15, 2011 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Mercy Medical Center Current Accepting new patients
Mercy Medical Center Diagnostic Radiology CurrentSince Jan 15, 2011 Accepting new patients
Swedish Medical Center-Radia Issaquah Imaging Center LLC Diagnostic Radiology Past Accepting new patients
Swedish Radia Imaging Center at Edmonds LLC Diagnostic Radiology Past Accepting new patients
Radia Inc P S Diagnostic Radiology Past Accepting new patients
Public Hospital District No 4, King County Wa Past Accepting new patients
Evergreen Radia LLC Diagnostic Radiology Past Accepting new patients
Lutheran Charity Association Past Accepting new patients
Public Hospital District No 4 King County Washington Past Accepting new patients
Swedish First Hill Diagnostic Imaging, LLC Diagnostic Radiology Past Accepting new patients
Advanced Diagnostic Radiology PC Diagnostic Radiology Past Accepting new patients
Everett Radia LLC Diagnostic Radiology Past Accepting new patients

Locations

3369 Solutions Ctr
Chicago, IL 60677

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

1301 15th Ave W
Williston, ND 58801
Phone (701) 774-7400

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 6

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1639389133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 142 PLACE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073231",
            "telephone_number": "318-675-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE. W.",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7400",
            "fax_number": "701-774-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "MADHUSUDHAN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "14725R",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "60041527",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "11765",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.094848",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15376",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

Verify at the official NPI Registry.