NPIMap

Individual provider Active NPI

Madhu Sudan, MD

  • Nephrology Physician
  • Covina, CA
National Provider Identifier
1679674923
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A-31769 Issued in CA
Practice address
500 W Badillo St
Covina, CA 91722-3762
Phone
(626) 915-6683
Fax
(626) 915-6684
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A-31769 CA Primary

Addresses

Primary practice location

500 W Badillo St
Covina, CA 91722-3762

Mailing address

500 W Badillo St
Covina, CA 91722-3762
Phone (626) 915-6683

Other identifiers 1

IdentifierTypeStateIssuer
00A317690MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20060310000401 CA Practitioner - Internal MedicinePractitioner - NephrologyPractitioner - Critical Care (Intensivists) 9436166717 Practice locations: Covina, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Critical Care (Intensivists), Nephrology
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

500 W Badillo St
Covina, CA 91722-3762
Phone (626) 915-6683

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A-31769CAMDNephrology Physician
31769CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Emanate Health Foothill Presbyterian Hospital Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Shanti Prakash Inc PastSince Mar 4, 1998 Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 4

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1679674923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917223762",
            "telephone_number": "626-915-6683",
            "fax_number": "626-915-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917223762",
            "telephone_number": "626-915-6683",
            "fax_number": "626-915-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDAN",
        "first_name": "MADHU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A-31769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A317690",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.