NPIMap

Individual provider Active NPI

Radha Podugu, M.D.

  • Internal Medicine Physician
  • Canton, OH
National Provider Identifier
1780653634
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35071855P Issued in OH
Practice address
2600 Tuscarawas St W
Suite#500
Canton, OH 44708-4644
Phone
(330) 452-8858
Fax
(330) 452-7797
NPI assigned
Mar 14, 2006
Last updated
Apr 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35071855P OH Primary

Addresses

Primary practice location

2600 Tuscarawas St W
Suite#500
Canton, OH 44708-4644

Mailing address

2600 Tuscarawas St W
Suite#500
Canton, OH 44708-4644
Phone (330) 452-8858

Other identifiers 1

IdentifierTypeStateIssuer
2017936MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address radhapodugu@mansardmed.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100726000078 OH Practitioner - Internal Medicine 0143265223 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2600 Tuscarawas St W
Suite 600
Canton, OH 44708-4676
Phone (330) 453-4300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35071855POHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stark County Pathologists Inc Current Accepting new patients
Aultman North Canton Medical Group CurrentSince Oct 1, 2022 Accepting new patients
Canton Aultman Emergency Physicians Inc Current Accepting new patients
North Canton Medical Foundation Past Accepting new patients

Locations

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

2600 Tuscarawas St W
Ste 500
Canton, OH 44708
Phone (330) 452-8858

2600 Tuscarawas St W
Ste 600
Canton, OH 44708
Phone (330) 453-4300

Interoperability endpoints

  • Direct secure messaging: radha.podugu@direct.aultman.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1780653634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 TUSCARAWAS ST W",
            "address_2": "SUITE#500",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447084644",
            "telephone_number": "330-452-8858",
            "fax_number": "330-452-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 TUSCARAWAS ST W",
            "address_2": "SUITE#500",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447084644",
            "telephone_number": "330-452-8858",
            "fax_number": "330-452-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODUGU",
        "first_name": "RADHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35071855P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017936",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "radhapodugu@mansardmed.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "direct email via employer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2600 Tuscarawas St W",
            "address_2": "Suite#500",
            "city": "Canton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "447084644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.