NPIMap

Individual provider Active NPI

Kadarnath Shammie Boodram, MD

  • Internal Medicine Physician
  • Prince George, VA
National Provider Identifier
1679546923
Registry record updated Mar 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101229800 Issued in VA
Practice address
4300 Crossings Blvd Ste 101
Prince George, VA 23875-1452
Phone
(804) 526-7900
Fax
(804) 526-7195
NPI assigned
Feb 8, 2006
Last updated
Mar 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101229800 VA Primary

Addresses

Primary practice location

4300 Crossings Blvd Ste 101
Prince George, VA 23875-1452

Mailing address

410 Ravenscroft Rd
South Prince George, VA 23805-7121
Phone (804) 526-7900

Other practice location 1

430 Clairmont Ct Ste 123
Colonial Heights, VA 23834-1770
Phone (804) 526-7900

Other identifiers 12

IdentifierTypeStateIssuer
254668OtherVASOUTHERN HEALTH
54180OtherVACARENET
0408689OtherVIUNITED HEALTHCARE
7604973OtherVAGHI
8130003OtherVAMAMSI
010124701OtherVAVIRGINIA PREMIERE
010124701MedicaidVA
7404178OtherVAAETNA PPO
94167OtherVISENTARA/OPTIMA
0504963OtherVACIGNA
3689195OtherVAAETNA HMO
172714OtherVAANTHEM BC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20040505001229 VA Practitioner - Internal Medicine 4880682905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4300 Crossings Blvd
Prince George, VA 23875-1452
Phone (804) 526-7900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.42 of 100Reported as individual
Quality
100
Promoting interoperability
93
Improvement activities
40
Cost
77.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101229800VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kadarnath S Boodram MD LLC Internal Medicine CurrentSince Dec 4, 2004 Accepting new patients

Locations

430 Clairmont Ct
Ste 123
Colonial Hgts, VA 23834
Phone (804) 526-1130

601 Old Wagner Rd
Ste 103
Petersburg, VA 23805
Phone (804) 526-3821

4300 Crossings Blvd
Prince George, VA 23875
Phone (804) 526-7900

4300 Crossings Blvd
Ste 101
Prince George, VA 23875
Phone (804) 526-7900

Interoperability endpoints

  • Direct secure messaging: kadarnath.boodram@kadarnathboodram.chartmakerdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710028800000",
    "number": "1679546923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 RAVENSCROFT RD",
            "city": "SOUTH PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238057121",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 CROSSINGS BLVD STE 101",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751452",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 Clairmont Ct Ste 123",
            "address_purpose": "LOCATION",
            "city": "Colonial Heights",
            "state": "VA",
            "postal_code": "238341770",
            "country_code": "US",
            "telephone_number": "804-526-7900",
            "fax_number": "804-526-7195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOODRAM",
        "first_name": "KADARNATH",
        "middle_name": "SHAMMIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-03-10",
        "certification_date": "2024-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101229800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "254668",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARENET",
            "identifier": "54180",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0408689",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "7604973",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "8130003",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA PREMIERE",
            "identifier": "010124701",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010124701",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA  PPO",
            "identifier": "7404178",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA/OPTIMA",
            "identifier": "94167",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0504963",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3689195",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "172714",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince George, VA

Sources for this page

Verify at the official NPI Registry.