Brahmananda Kiran Koduri, M.D

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

9302A Issued in WY

Practice address

501 S Burma Ave
Gillette, WY 82716-3426

Phone

(307) 688-1534

NPI assigned

Nov 3, 2009

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 WY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/dcf3b1c6-3971-4673-962e-8b2cce0ff827/
• Direct secure messaging: brahmananda.koduri@direct.wyomingmedicalcenter.org

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 Hospital Based Physicians West LLC

  • Multi-Specialty Clinic/Center
  • Casper, WY
  • NPI 1619464120
  Medicare reassignment NPD
• Campbell County Hospital District

  • Internal Medicine Physician
  • Gillette, WY
  • NPI 1710098868
  Medicare reassignment NPD
• Ivinson Memorial Hospital

  • Rural Health Clinic/Center
  • Laramie, WY
  • NPI 1033628599
  Medicare reassignment NPD
• Memorial Hospital of Laramie County

  • General Acute Care Hospital
  • Cheyenne, WY
  • NPI 1285621839
  Medicare reassignment NPD
• Memorial Hospital of Sweetwater County

  • Critical Access Hospital
  • Rock Springs, WY
  • NPI 1558361949
  Medicare reassignment NPD
• Campbell County Hospital District

  • Emergency Medicine Physician
  • Gillette, WY
  • NPI 1063575611
  NPD
• Campbell County Hospital District

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gillette, WY
  • NPI 1881730141
  NPD
• Campbell County Hospital District

  • Community/Retail Pharmacy
  • Gillette, WY
  • NPI 1992874218
  NPD
• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1366626269
  NPD
• Memorial Hospital of Sweetwater County

  • Internal Medicine Physician
  • Rock Springs, WY
  • NPI 1437312436
  NPD
• Banner Hospital Based Physicians West LLC

  • Multi-Specialty Clinic/Center
  • Ogallala, NE
  • NPI 1144025446
  NPD
• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1336289552
  NPD (past)

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378166400000",
    "number": "1659608214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 RUNNING W DR APT 101",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827182033",
            "telephone_number": "609-216-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODURI",
        "first_name": "BRAHMANANDA",
        "middle_name": "KIRAN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-03",
        "last_updated": "2013-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "WY",
            "license": "9302A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Renae Knight, RN
• Dianna L Knox, LPC, ED.D., NCC
• Jessica Knust
• Amber Knuths, CRNA
• Braeden L Knutson, DPT
• Sarah Lynn Koehn, O.D.
• Susy Kraft, PCSW
• Carol Christine Kramer, NCSP, ABSNP
• Chelsi Jean Krehmeyer, PA-C
• Kelsey Krei

• Pediatric Critical Care Medicine Physician in Gillette, WY
• Providers in Gillette, WY by specialty
• Pediatric Critical Care Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.