NPIMap

Individual provider Active NPI

Anuradha Gonuguntla, MD

  • Family Medicine Physician
  • Glen Allen, VA
National Provider Identifier
1811176704
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7823 Issued in SD
Practice address
5360 Twin Hickory Rd
Glen Allen, VA 23059-5682
Phone
(804) 346-3200
Fax
(804) 346-4075
NPI assigned
Oct 29, 2007
Last updated
Jun 1, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RL10545 ND
Family Medicine Physician 207Q00000X 7823 SD Primary

Addresses

Primary practice location

5360 Twin Hickory Rd
Glen Allen, VA 23059-5682

Mailing address

1800 Glenside Dr
Ste 105
Richmond, VA 23226-3769
Phone (804) 288-2762

Other identifiers 1

IdentifierTypeStateIssuer
12083MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150107000929 DC Practitioner - Family Practice 6406971175 Reassigns benefits to 1 organization
I20150127001161 VA Practitioner - Family Practice 6406971175 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonwealth Primary CareGroup PAC ID 2264420918, 65 clinicians
Professional Therapies of Roanoke, Inc.Group PAC ID 3375710619, shared by 5 NPIs, 272 clinicians

Practice addresses (Care Compare)

5360 Twin Hickory Rd
Glen Allen, VA 23059-5682
Phone (804) 346-6200

6800 Woodlake Commons Loop
Midlothian, VA 23112-2281
Phone (804) 302-4589

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RL10545NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Richmond Medical Group PLLC Family Medicine CurrentSince Oct 23, 2014 Accepting new patients
Patient First Richmond Medical Group PLLC Family Medicine CurrentSince Oct 23, 2014 Accepting new patients
Commonwealth Primary Care Family Medicine CurrentSince Jun 1, 2016 Accepting new patients
Commonwealth Primary Care Family Medicine Past Accepting new patients

Locations

6311 Richmond Hwy
Alexandria, VA 22306
Phone (703) 647-6087

5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355

5360 Twin Hickory Rd
Glen Allen, VA 23059
Phone (804) 346-3200

601 Potomac Station Dr NE
Leesburg, VA 20176
Phone (703) 840-1396

7140 Hull Street Rd
Ste 101
North Chesterfield, VA 23235
Phone (804) 276-4141

1800 Glenside Dr
Ste 105
Richmond, VA 23226
Phone (804) 288-0399

1800 Glenside Dr
Ste 110
Richmond, VA 23226
Phone (804) 288-1800

Interoperability endpoints

  • Direct secure messaging: anuradha.gonuguntla@cpcva.eclinicaldirectplus.com

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1811176704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GLENSIDE DR",
            "address_2": "STE 105",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232263769",
            "telephone_number": "804-288-2762",
            "fax_number": "804-285-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 TWIN HICKORY RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595682",
            "telephone_number": "804-346-3200",
            "fax_number": "804-346-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONUGUNTLA",
        "first_name": "ANURADHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-29",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "RL10545",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "7823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12083",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.