NPIMap

Individual provider Active NPI

Jyotsna Koduri, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Denver, CO
National Provider Identifier
1679033096
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
1679033096 Issued in CA
Practice address
1960 N Ogden St Ste 400
Denver, CO 80218-3670
Phone
(303) 318-1540
NPI assigned
Mar 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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 CO
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 1679033096 CA Primary

Addresses

Primary practice location

1960 N Ogden St Ste 400
Denver, CO 80218-3670

Mailing address

4 E 113TH Ter
Kansas City, MO 64114-5448

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20251023004238 OK Practitioner - Physical Medicine and Rehabilitation 1052641800 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Oklahoma College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3433 NW 56TH St
Suite 900
Oklahoma City, OK 73112-4452
Phone (405) 552-0401

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.91 of 100Reported as apm
Quality
77.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1679033096CAMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation CurrentSince Oct 13, 2025 Accepting new patients
Integris Ambulatory Care C Orporation Past Accepting new patients

Locations

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

3433 NW 56th St
Ste 900
Oklahoma City, OK 73112
Phone (405) 552-0401

Interoperability endpoints

  • Direct secure messaging: jkoduri546203@direct.integrisok.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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1679033096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 E 113TH TER",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641145448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 N OGDEN ST STE 400",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183670",
            "telephone_number": "303-318-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODURI",
        "first_name": "JYOTSNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-21",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "1679033096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.