NPIMap

Individual provider Active NPI

Rajendra Potluri, M.D.

  • Hospitalist Physician
  • Fargo, ND
National Provider Identifier
1679562953
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
9227 Issued in ND
Practice address
801 Broadway N
Fargo, ND 58102-3641
Phone
(701) 234-2731
Fax
(701) 234-2158
NPI assigned
Oct 19, 2005
Last updated
Oct 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9227 ND
Hospitalist Physician 208M00000X 9227 ND Primary

Addresses

Primary practice location

801 Broadway N
Fargo, ND 58102-3641

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other identifiers 10

IdentifierTypeStateIssuer
CF8850OtherNDRAILROAD MEDICARE
25978OtherNDBLUE SHIELD
28579OtherNDBLUE SHIELD
28583OtherNDBLUE SHIELD
12271MedicaidND
28582OtherNDBLUE SHIELD
22610OtherNDBLUE SHIELD
28581OtherNDBLUE SHIELD
P00003010OtherNDRAILROAD MEDICARE
28580OtherNDBLUE SHIELD

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
I20040510001022 ND Practitioner - HospitalistPractitioner - Internal Medicine 2264421742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

1720 University Dr S
Fargo, ND 58103-4940
Phone (701) 234-2000

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9227NDMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Internal Medicine CurrentSince May 25, 2011 Accepting new patients
Sanford Medical Center Fargo CurrentSince May 25, 2011 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients
Southeast Medical Center PC Past Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients
Sanford Clinic North Past Accepting new patients
Vibra Hospital of Fargo LLC Past Accepting new patients
Sanford Clinic North Past Accepting new patients

Locations

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121

42 6th Ave SE
Mayville, ND 58257
Phone (701) 786-3800

420 S 7th St
Oakes, ND 58474
Phone (701) 742-3267

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 8

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1679562953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-2731",
            "fax_number": "701-234-2158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTLURI",
        "first_name": "RAJENDRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "9227",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "ND",
            "license": "9227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF8850",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "25978",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28579",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28583",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12271",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28582",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "22610",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28581",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00003010",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "28580",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.