NPIMap

Individual provider Active NPI

Padmaja Kodali, MD

  • Nephrology Physician
  • Maplewood, NJ
National Provider Identifier
1790747764
Registry record updated Dec 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
25MA06878300 Issued in NJ
Practice address
2040 Millburn Ave
Suite 403
Maplewood, NJ 07040-3726
Phone
(973) 763-1100
Fax
(973) 763-1122
NPI assigned
Apr 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 25MA06878300 NJ Primary

Addresses

Primary practice location

2040 Millburn Ave
Suite 403
Maplewood, NJ 07040-3726

Mailing address

2040 Millburn Ave
Suite 403
Maplewood, NJ 07040-3726
Phone (973) 763-1100

Other identifiers 1

IdentifierTypeStateIssuer
8348707MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20040426000054 NJ Practitioner - Internal MedicinePractitioner - Nephrology 2062408867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1979 Springfield Ave
FL 1
Maplewood, NJ 07040-3435
Phone (973) 763-1100

Hospital & facility affiliations

  • Alaris Health at Essex Dialysis facility, Irvington, NJ, CCN 312676
  • Vistacare Dialysis Center Dialysis facility, Newark, NJ, CCN 312711
  • DaVita Irvington Dialysis Dialysis facility, Irvington, NJ, CCN 312683
  • DaVita Hillside Dialysis Dialysis facility, Hillside, NJ, CCN 312587
  • DaVita West Orange Dialysis Dialysis facility, West Orange, NJ, CCN 312636
  • Cooperman Barnabas Medical Center Hospital, Livingston, NJ, CCN 310076
  • Newark Beth Israel Medical Center Hospital, Newark, NJ, CCN 310002
  • Saint Michael'S Medical Center Hospital, Newark, NJ, CCN 310096
  • Carewell Health Medical Center Hospital, East Orange, NJ, CCN 310083
  • Clara Maass Medical Center Hospital, Belleville, NJ, CCN 310009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA06878300NJMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cooperman Barnabas Medical Center Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: pkodali249413@epicdirect.rwjbh.org

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355702400000",
    "number": "1790747764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 MILLBURN AVE",
            "address_2": "SUITE 403",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403726",
            "telephone_number": "973-763-1100",
            "fax_number": "973-763-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 MILLBURN AVE",
            "address_2": "SUITE 403",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403726",
            "telephone_number": "973-763-1100",
            "fax_number": "973-763-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODALI",
        "first_name": "PADMAJA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2012-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA06878300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8348707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, NJ

Sources for this page

Verify at the official NPI Registry.