Individual provider Active NPI

Madhusudan Vijayan

  • Internal Medicine Physician
  • Bronx, NY
National Provider Identifier
1770078487
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD.47724 Issued in AL
Practice address
1400 Pelham Pkwy S
Bronx, NY 10461-1197
Phone
(718) 918-5000
NPI assigned
Jun 25, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD.47724 AL Primary

Addresses

Primary practice location

1400 Pelham Pkwy S
Bronx, NY 10461-1197

Mailing address

1400 Pelham Pkwy S
Bronx, NY 10461-1197

Other practice location 1

1400 Pelham Pkwy S
Bronx, NY 10461-1197
Phone (617) 710-6254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241017000712 AL Practitioner - Internal Medicine 9537691365 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cogent Healthcare of Decatur, LLCGroup PAC ID 0446141972, 13 clinicians

Practice addresses (Care Compare)

809 University Blvd E
Tuscaloosa, AL 35401-2029
Phone (205) 759-7111

Hospital & facility affiliations

  • DCH Regional Medical Center Hospital, Tuscaloosa, AL, CCN 010092

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.47724ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The DCH Health Care Authority CurrentSince Jul 28, 2024 Accepting new patients
Cogent Healthcare of Decatur, LLC Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
DCH Healthcare Authority Internal Medicine Current Accepting new patients
West Alabama Palliative Care Service LLC Current Accepting new patients
The DCH Healthcare Authority CurrentSince Jul 28, 2024 Accepting new patients

Locations

809 University Blvd E
Tuscaloosa, AL 35401
Phone (205) 333-4661

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Organizations & group practices 5

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1770078487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611197",
            "telephone_number": "718-918-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Pelham Pkwy S",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104611197",
            "country_code": "US",
            "telephone_number": "617-710-6254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIJAYAN",
        "first_name": "MADHUSUDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "MD.47724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.