NPIMap

Individual provider Active NPI

Venkata Susrut Pendyala, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Richland, WA
National Provider Identifier
1831444553
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
MD61171799 Issued in WA
Practice address
1100 Goethals Dr Ste F
Richland, WA 99352-3301
Phone
(509) 942-3272
Fax
(509) 942-3273
NPI assigned
Jul 18, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-138524 IL
Internal Medicine Physician 207R00000X MD61171799 WA
Cardiovascular Disease Physician 207RC0000X MD61171799 WA
Clinical Cardiac Electrophysiology Physician 207RC0001X MD61171799 WA Primary

Addresses

Primary practice location

1100 Goethals Dr Ste F
Richland, WA 99352-3301

Mailing address

550 Gage Blvd Ste 101
Richland, WA 99352-9532
Phone (509) 942-3627

Other practice location 1

701 N 1st St
Springfield, IL 62702-3757
Phone (217) 545-0182

Other identifiers 1

IdentifierTypeStateIssuer
036138524MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20210907000471 WA Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3476869082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1802 Yakima Ave
Suite 302
Tacoma, WA 98405-5305
Phone (253) 627-1244

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair52

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-138524ILMDInternal Medicine Physician
MD61171799WAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Dec 6, 2022 Accepting new patients
Multicare Health System Current Accepting new patients
Franciscan Medical Group CurrentSince Jul 15, 2024 Accepting new patients
Multicare Health System CurrentSince Dec 6, 2022 Accepting new patients
Franciscan Medical Group Internal Medicine CurrentSince Jul 15, 2024 Accepting new patients
Franciscan Medical Group Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

1802 Yakima Ave
Ste 302
Tacoma, WA 98405
Phone (253) 591-6739

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 6

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": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1831444553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-942-3627",
            "fax_number": "509-627-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GOETHALS DR STE F",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523301",
            "telephone_number": "509-942-3272",
            "fax_number": "509-942-3273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-0182",
            "fax_number": "217-545-4735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDYALA",
        "first_name": "VENKATA",
        "middle_name": "SUSRUT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-18",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-138524",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61171799",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD61171799",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WA",
            "license": "MD61171799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036138524",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richland, WA

Sources for this page

Verify at the official NPI Registry.