Active NPI
Kamala B Modur, MD
- Radiation Oncology Physician
- Valparaiso, IN
National Provider Identifier
1689656985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 01032505
- Practice address
- 54 Roosevelt Rd
Valparaiso, IN 46383-5845 - Phone
- (219) 462-8246
- Fax
- (219) 462-7902
- NPI assigned
- Nov 14, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 01032505 | IN | Primary |
Addresses
Primary practice location
54 Roosevelt Rd
Valparaiso, IN 46383-5845
Mailing address
Dept 6064
Carol Stream, IL 60122
Phone (219) 462-8246
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200008730A | Medicaid | IN | |
| 000000090695 | Other | IN | ANTHEM BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01032505 | IN | MD | Radiation Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Koppolu P Sarma MD Inc | Radiation Oncology | Past | Accepting new patients |
| Northern Indiana Oncology Center of Porter Memorial Hospital LLC | Radiation Oncology | Past | Accepting new patients |
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.
-
- Radiation Oncology Physician
- Valparaiso, IN
- NPI 1912953043
Radiation Oncology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279756800000",
"number": "1689656985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT 6064",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "60122",
"telephone_number": "219-462-8246",
"fax_number": "219-462-7902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 ROOSEVELT RD",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463835845",
"telephone_number": "219-462-8246",
"fax_number": "219-462-7902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODUR",
"first_name": "KAMALA",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-14",
"last_updated": "2010-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IN",
"license": "01032505",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200008730A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000090695",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.