NPIMap

Individual provider Active NPI

Vasudevarao Jonnalagadda, MD

  • Nephrology Physician
  • Jersey City, NJ
National Provider Identifier
1669470308
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
25MA06324000 Issued in NJ
Practice address
3438 John F Kennedy Blvd
Jersey City, NJ 07307-4166
Phone
(201) 420-0366
Fax
(201) 420-6422
NPI assigned
Jul 7, 2005
Last updated
Aug 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 25MA06324000 NJ Primary
Nephrology Physician 207RN0300X 199878-1 NY

Addresses

Primary practice location

3438 John F Kennedy Blvd
Jersey City, NJ 07307-4166

Mailing address

3438 John F Kennedy Blvd
Jersey City, NJ 07307-4166
Phone (201) 420-0366

Other identifiers 6

IdentifierTypeStateIssuer
0036536MedicaidNJ
01918538MedicaidNY
043714808OtherNJHORIZON B/C B/S
P00094722OtherNJRAILROAD MEDICARE
7378106MedicaidNJ
DB2462OtherNJRAILROAD MEDICARE GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20040504000150 NJ Practitioner - Nephrology 1456349919 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Padmavathi Jonnalagadda MD PAGroup PAC ID 9234126228, 2 clinicians

Practice addresses (Care Compare)

3438 John F Kennedy Blvd
Jersey City, NJ 07307-4166
Phone (201) 420-0366

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA06324000NJMDNephrology Physician
199878-1NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ijkg Opco LLC Current Accepting new patients
Padmavathi Jonnalagadda MD PA Nephrology CurrentSince Jan 1, 2004 Accepting new patients
Bassam M Haddad, MD, PA Past Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14360/brand/9/csg/1/fhir/r4
  • Direct secure messaging: vasudeva.jonnalagadda@direct.bayonnemedicalcenter.md
  • Direct secure messaging: vjonnalagadda11477@nychhc.direct-ci.com

Organizations & group practices 3

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 7

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1669470308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3438 JOHN F KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073074166",
            "telephone_number": "201-420-0366",
            "fax_number": "201-420-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3438 JOHN F KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073074166",
            "telephone_number": "201-420-0366",
            "fax_number": "201-420-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONNALAGADDA",
        "first_name": "VASUDEVARAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA06324000",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "199878-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0036536",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01918538",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON B/C B/S",
            "identifier": "043714808",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00094722",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7378106",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "DB2462",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.