Madan Mohan Reddy Koppolu, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

51854 Issued in TN

Practice address

309 Jackson St
Monroe, LA 71201-7407

Phone

(318) 966-4000

NPI assigned

Aug 18, 2008

Last updated

Aug 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Internal Medicine

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hospitalist Medicine Physicians of Texas PLLCGroup PAC ID 3476688318, 685 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
• Covenant Health Hobbs Hospital Hospital, Hobbs, NM, CCN 320065
• Lamb Healthcare Center Hospital, Littlefield, TX, CCN 450698

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095
  Medicare reassignment Care Compare group NPD
• Hospital Medicine Services of Tennessee PC

  • Hospitalist Physician
  • Lawrenceburg, IN
  • NPI 1528433802

  Internal Medicine, TN

  Medicare reassignment NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  Internal Medicine

  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  TN

  Medicare reassignment NPD
• Covenant Medical Center

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1972517365
  NPD (past)

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

• Covenant Hospital Hobbs

  dba Covenant Health Hobbs Hospital

  • General Acute Care Hospital
  • Hobbs, NM
  • NPI 1215534466
  Care Compare affiliation
• Covenant Medical Center

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1972517365
  Care Compare affiliation
• Lamb Healthcare Center

  • General Acute Care Hospital
  • Littlefield, TX
  • NPI 1700854288
  Care Compare affiliation

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1700033032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8312 MISTY CREEK DR",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381387604",
            "telephone_number": "520-906-7591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 JACKSON ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017407",
            "telephone_number": "318-966-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPOLU",
        "first_name": "MADAN",
        "middle_name": "MOHAN REDDY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-18",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "51854",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "LA",
            "license": "MD204817",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Monroe, LA
• Providers in Monroe, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.