NPIMap

Organization Active NPI

Bodavula MD LLC

  • Clinic/Center
  • Creve Coeur, MO
National Provider Identifier
1790183077
Registry record updated Dec 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2010007564 Issued in MO
Legal business name
BODAVULA MD LLC
Practice address
709 Turrentine TRL
Creve Coeur, MO 63141-6089
Phone
(914) 563-2943
NPI assigned
Dec 18, 2014
Last updated
Dec 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2014

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

Authorized official

Name
Dr. Venkata KR Bodavula, MDNPI 1275714784
Title
Surgeon
Phone
(914) 563-2943

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2010007564 MO Primary

Addresses

Primary practice location

709 Turrentine TRL
Creve Coeur, MO 63141-6089

Mailing address

709 Turrentine TRL
Creve Coeur, MO 63141-6089
Phone (914) 563-2943

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150512000091 MO Part B Supplier - Clinic/Group Practice 4587983697 Receives reassigned benefits from 2 practitioners
Practice locations: Bridgeton, MO; Saint Louis, MO; Saint Peters, MO; Troy, MO

National Provider Directory

National Provider Directory

Locations

11155 Dunn Rd
Ste 206E
Saint Louis, MO 63136
Phone (314) 355-6700

555 N New Ballas Rd
Ste 175
Saint Louis, MO 63141
Phone (314) 786-2663

5600 Mexico Rd
Ste 21
Saint Peters, MO 63376
Phone (636) 373-9882

1000 E Cherry St
Ste 321
Troy, MO 63379
Phone (573) 221-0304

1004 E Cherry St
Ste 321
Troy, MO 63379
Phone (636) 373-9882

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1790183077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 TURRENTINE TRL",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416089",
            "telephone_number": "914-563-2943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 TURRENTINE TRL",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416089",
            "telephone_number": "914-563-2943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODAVULA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-18",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "BODAVULA",
        "authorized_official_first_name": "VENKATA",
        "authorized_official_middle_name": "KR",
        "authorized_official_title_or_position": "SURGEON",
        "authorized_official_telephone_number": "914-563-2943",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MO",
            "license": "2010007564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.