Active NPI
Markandeya Madabattula
- Internal Medicine Physician
- Columbia, MO
National Provider Identifier
1710407689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 2017021066
- Practice address
- 1 Hospital Dr # Dc043.00
Columbia, MO 65212-1000 - Phone
- (573) 884-9066
- NPI assigned
- Jun 22, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2017021066 | MO | Primary |
Addresses
Primary practice location
1 Hospital Dr # Dc043.00
Columbia, MO 65212-1000
Mailing address
624 Leger Way
Edmonton, ALBERTA T6R 0C2
CA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017021066 | MO | MD | Internal Medicine Physician |
Interoperability endpoints
- mmadabattula574615@direct.peacehealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592524800000",
"number": "1710407689",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "624 LEGER WAY",
"city": "EDMONTON",
"state": "ALBERTA",
"postal_code": "T6R 0C2"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HOSPITAL DR # DC043.00",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652121000",
"telephone_number": "573-884-9066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADABATTULA",
"first_name": "MARKANDEYA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-22",
"last_updated": "2020-06-19",
"certification_date": "2020-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "2017021066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.