NPIMap

Organization Active NPI

Riverside Medical Associates PA

Doing business as None

  • Endocrinology, Diabetes & Metabolism Physician
  • Riverdale, MD
National Provider Identifier
1730132648
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
RIVERSIDE MEDICAL ASSOCIATES PA
Doing business as
None
Practice address
6502 Kenilworth Ave
Suite 100
Riverdale, MD 20737-1370
Phone
(301) 927-0088
Fax
(301) 927-7239
NPI assigned
May 19, 2006
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

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

Authorized official

Name
Madhu Mohan Katikineni, MDNPI 1235182163
Title
President
Phone
(301) 927-0088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU Primary
Gastroenterology Physician 207RG0100X NU
Hematology & Oncology Physician 207RH0003X NU
Nephrology Physician 207RN0300X NU
Nuclear Cardiology Physician 207UN0901X NU
Body Imaging Physician 2085B0100X NU
Diagnostic Radiology Physician 2085R0202X NU
Urology Physician 208800000X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

6502 Kenilworth Ave
Suite 100
Riverdale, MD 20737-1370

Mailing address

6502 Kenilworth Ave
Suite 100
Riverdale, MD 20737-1370
Phone (301) 927-0088

Other identifiers 1

IdentifierTypeStateIssuer
299741000MedicaidMD

Other names 1

  • NONE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000165 DC Part B Supplier - Clinic/Group Practice 9830086487 Receives reassigned benefits from 10 practitioners
Practice locations: Bowie, MD; Riverdale, MD; Upper Marlboro, MD

National Provider Directory

National Provider Directory

Locations

6504 Kenilworth Ave
Ste 200
Riverdale, MD 20737
Phone (301) 927-8011

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24726/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1730132648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 KENILWORTH AVE",
            "address_2": "SUITE 100",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371370",
            "telephone_number": "301-927-0088",
            "fax_number": "301-927-7239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 KENILWORTH AVE",
            "address_2": "SUITE 100",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371370",
            "telephone_number": "301-927-0088",
            "fax_number": "301-927-7239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "KATIKINENI",
        "authorized_official_first_name": "MADHU",
        "authorized_official_middle_name": "MOHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-927-0088",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299741000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NONE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.