Active NPI
Nagabhushana Nimmagadda
- Anatomic Pathology & Clinical Pathology Physician
- Melville, NY
National Provider Identifier
1750467494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 149316
- Practice address
- 80 Marcus Dr
Provider Enrollment Department
Melville, NY 11747-4230 - Phone
- (631) 391-7887
- Fax
- (631) 454-4163
- NPI assigned
- Oct 27, 2006
- Last updated
- Dec 1, 2015
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 149316 | NY | Primary |
Addresses
Primary practice location
80 Marcus Dr
Provider Enrollment Department
Melville, NY 11747-4230
Mailing address
1900 Hempstead Turnpike
Suite 500
East Meadow, NY 11554
Phone (516) 542-1090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00763502 | Medicaid | NY |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Linden Pathology Associates LLP | Anatomic Pathology & Clinical Pathology | Past | Accepting new patients |
| University Group Medical Associates, P.C | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Brooklyn, NY
- NPI 1124104922
-
dba Coney Island Medical Group
- Diagnostic Radiology Physician
- Brooklyn, NY
- NPI 1285683102
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448928000000",
"number": "1750467494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 HEMPSTEAD TURNPIKE",
"address_2": "SUITE 500",
"city": "EAST MEADOW",
"state": "NY",
"postal_code": "11554",
"telephone_number": "516-542-1090",
"fax_number": "516-794-8165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 MARCUS DR",
"address_2": "PROVIDER ENROLLMENT DEPARTMENT",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474230",
"telephone_number": "631-391-7887",
"fax_number": "631-454-4163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIMMAGADDA",
"first_name": "NAGABHUSHANA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2015-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NY",
"license": "149316",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00763502",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.