NPIMap

Individual provider Active NPI

Sri Vardhan Reddy Kooturu, M.D.

  • Internal Medicine Physician
  • Fargo, ND
National Provider Identifier
1760633457
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11281 Issued in ND
Practice address
801 Broadway N
Fargo, ND 58102-3641
Phone
(701) 234-2731
NPI assigned
Oct 1, 2008
Sex
Male
Sole proprietor
No

Organizations & group practices 7

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.

Hospital & facility affiliations 12

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

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pro Care Medical Group Inc 2 clinicians

Practice addresses (Care Compare)

1155 Rock Creek Way
Concord, CA 94521-5022
Phone (925) 322-3442

Hospital & facility affiliations

  • Athome Healthcare Team - East Bay, LLC Home health agency, Walnut Creek, CA, CCN 559246
  • John Muir Home Health Services Home health agency, Concord, CA, CCN 057276
  • Warm Springs Home Health, Inc Home health agency, Fremont, CA, CCN 058425
  • Continuum Care Hospice LLC Hospice, Concord, CA, CCN 751626
  • John Muir Medical Center - Walnut Creek Campus Hospital, Walnut Creek, CA, CCN 050180
  • John Muir Medical Center - Concord Campus Hospital, Concord, CA, CCN 050496
  • Eden Medical Center Hospital, Castro Valley, CA, CCN 050488
  • Shadelands Post Acute Nursing home, Walnut Creek, CA, CCN 555926
  • Stonebrook Post Acute Nursing home, Concord, CA, CCN 555421
  • Rossmoor Post Acute Nursing home, Walnut Creek, CA, CCN 555446
  • Pleasant Hill Post Acute Nursing home, Pleasant Hill, CA, CCN 055049
  • Tampico Healthcare Center Nursing home, Walnut Creek, CA, CCN 056213

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111010000290 CA Practitioner - Internal Medicine 6608929948 Reassigns benefits to 5 organizations

All facility ownership & control disclosures 4

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rosewood Post AcutePleasant Hill, CA, CCN 056476 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2017
May 1, 2017
Diablo Valley Post AcuteConcord, CA, CCN 055150 Skilled nursing facility Contracted Managing Employee Feb 1, 2023
Morro Bay Holdings LLCConcord, CA, CCN 555421 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2025
Nov 1, 2025
Continuum Care Hospice LLCConcord, CA, CCN 751626 Hospice Contracted Managing Employee Nov 21, 2023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PT 11281NDMDInternal Medicine Physician
RL10211NDMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Physician Partners CurrentSince May 1, 2012 Accepting new patients
John Muir Physician Network CurrentSince Sep 1, 2015 Accepting new patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
Pro Care Medical Group Inc Internal Medicine CurrentSince Oct 18, 2017 Accepting new patients
Hospitalists of Modesto Medical Group Inc Internal Medicine CurrentSince Sep 1, 2011 Accepting new patients
John Muir Trauma Physicians Billing Service CurrentSince Mar 15, 2013 Accepting new patients
First Choice Physician Partners CurrentSince May 1, 2012 Accepting new patients

Locations

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

2700 Grant St
Ste 200
Concord, CA 94520
Phone (925) 674-2609

2540 East St
Concord, CA 94520
Phone (925) 674-2228

1541 Florida Ave
Modesto, CA 95350
Phone (209) 214-7049

1441 Florida Ave
Modesto, CA 95350
Phone (209) 214-7235

1541 Florida Ave
Ste 101
Modesto, CA 95350
Phone (209) 575-3839

1700 McHenry Ave
Ste 65B
Modesto, CA 95350
Phone (209) 581-7063

380 Civic Dr
Ste 100
Pleasant Hill, CA 94523
Phone (925) 284-3840

1850 Mt Diablo Blvd
Ste 545
Walnut Creek, CA 94596
Phone (925) 946-1080

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X RL10211 ND
Internal Medicine Physician 207R00000X PT 11281 ND
Internal Medicine Physician 207R00000X 11281 ND Primary

Addresses

NPPES NPI Registry

Primary practice location

801 Broadway N
Fargo, ND 58102-3641

Mailing address

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2731

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 22, 2011.

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1760633457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOTURU",
        "first_name": "SRI VARDHAN REDDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-01",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ND",
            "license": "RL10211",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "PT 11281",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "11281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.