NPIMap

Individual provider Active NPI

Sandeep Kodityal, MD

  • Hematology & Oncology Physician
  • Shenandoah, TX
National Provider Identifier
1790820736
Registry record updated Oct 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
L6990 Issued in TX
Practice address
18488 Interstate 45 S
Shenandoah, TX 77384-4118
Phone
(281) 569-2100
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X L6990 TX Primary

Addresses

Primary practice location

18488 Interstate 45 S
Shenandoah, TX 77384-4118

Mailing address

22710 Professional Dr Ste 102
Kingwood, TX 77339-6009
Phone (281) 358-2850

Other identifiers 1

IdentifierTypeStateIssuer
187751601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20070618000171 TX Practitioner - Hematology/Oncology 3173622057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Texas Tech University Health Science Center School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians

Practice addresses (Care Compare)

135 Vision Park Blvd
Shenandoah, TX 77384-3001
Phone (936) 235-7092

Hospital & facility affiliations

  • Memorial Hermann Hospital System Hospital, Houston, TX, CCN 450184
  • Houston Methodist the Woodlands Hospital Hospital, The Woodlands, TX, CCN 670122
  • Aspire Hospital Hospital, Conroe, TX, CCN 670093
  • HCA Houston Healthcare Conroe Hospital, Conroe, TX, CCN 450222

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physicians Association PLLC CurrentSince Oct 1, 2018 Accepting new patients
American Oncology Partners PA Hematology & Oncology CurrentSince Mar 14, 2024 Accepting new patients
Millennium Physicians Association, PLLC Hematology & Oncology CurrentSince Oct 1, 2018 Accepting new patients
Sadler Clinic Association Past Accepting new patients
Cardiovascular Care Providers, Inc. Past Accepting new patients

Locations

603 S Conroe Medical Dr
Ste 160
Conroe, TX 77304
Phone (936) 235-7093

603 S Conroe Medical Dr
Ste 100
Conroe, TX 77304
Phone (936) 235-7093

3201 S Austin Ave
Ste 315
Georgetown, TX 78626
Phone (512) 302-1210

800 Peakwood Dr
Ste 6F
Houston, TX 77090
Phone (281) 298-2847

20207 Chasewood Park Dr
Ste 300
Houston, TX 77070
Phone (832) 534-7800

22730 Professional Dr
Kingwood, TX 77339
Phone (281) 312-8545

22710 Professional Dr
Kingwood, TX 77339
Phone (281) 298-2847

22710 Professional Dr
Ste 102
Kingwood, TX 77339

18354 Interstate 45 S
Ste 200
Shenandoah, TX 77384
Phone (936) 235-7092

135 Vision Park Blvd
Shenandoah, TX 77384
Phone (281) 404-3000

18488 Interstate 45 S
Shenandoah, TX 77384
Phone (281) 315-8130

Interoperability endpoints

  • Direct secure messaging: sandeep.kodityal.p1@direct.mphcc.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: sandeep.kodityal@mpa.ikm.direct-ci.com

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 10

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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1790820736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22710 PROFESSIONAL DR STE 102",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773396009",
            "telephone_number": "281-358-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18488 INTERSTATE 45 S",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773844118",
            "telephone_number": "281-569-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODITYAL",
        "first_name": "SANDEEP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "L6990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187751601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

Verify at the official NPI Registry.