Ketankumar Bodarya, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2021-00515 Issued in NC

Practice address

2117 Broadway Drive
Hattiesburg, MS 39402-3210

Phone

(601) 288-8050

Fax

(601) 288-8058

NPI assigned

Feb 23, 2011

Last updated

Jun 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbodarya883042@direct.novanthealth.org

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.

• Forsyth Memorial Hospital, Inc.

  dba NH Forsyth Primary Care Clinics

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment Care Compare group NPD
• Forrest County General Hospital

  • Psychiatric Hospital Unit
  • Hattiesburg, MS
  • NPI 1295837631
  Medicare reassignment NPD
• Alamance Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Burlington, NC
  • NPI 1326010273
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Forrest County General Hospital

  dba Highland Center for Women's Health RHC

  • Rural Health Clinic/Center
  • Picayune, MS
  • NPI 1043820426
  NPD
• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809
  NPD
• Alamance Regional Medical Center, Inc

  dba ARMC Health Care Employee Pharmacy

  • Pharmacy
  • Burlington, NC
  • NPI 1851681993
  NPD
• Forsyth Memorial Hospital Inc

  dba Novant Health Psychiatry

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1508350349
  NPD
• Forsyth Memorial Hospital, Inc.

  dba Novant Health Heart & Vascular Institute - Frontis Plaza

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Psychiatric Medicine

  • Psychiatry Physician
  • Thomasville, NC
  • NPI 1114387370
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Forsyth Memorial Hospital, Inc.

  dba Novant Health Forsyth Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  NPD (past)

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

• Forsyth Memorial Hospital, Inc.

  dba Novant Health Forsyth Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1831496165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6501 N Charles St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212046819",
            "country_code": "US",
            "telephone_number": "401-938-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODARYA",
        "first_name": "KETANKUMAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-23",
        "last_updated": "2025-06-13",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "2021-00515",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MD",
            "license": "D0081182",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2021-00515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica V Blakley, FNP-C
• Bertha J Blanchard, MD
• Kevin P Blanchard, MD
• Bluebonnet Dental Care Hattiesburg LLC
• Lynn Boardman, MS,CCC-SLP
• Ernest Bodie, PCCSS
• Christine Boehmer, LPC
• Torkeshia Bolar
• Blake Edwin Boleware
• Empress Bolton

• Psychiatry Physician in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.