NPIMap

Individual provider Active NPI

Venkata Rama Gopala Sriharsha Damera, MBBS

  • Nephrology Physician
  • Shawnee, OK
National Provider Identifier
1861646358
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
28396 Issued in OK
Practice address
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone
(405) 273-5801
Fax
(405) 878-3814
NPI assigned
Nov 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28396 OK
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X 28396 OK Primary

Addresses

Primary practice location

3315 Kethley Rd
Shawnee, OK 74804-9638

Mailing address

PO Box 849
Shawnee, OK 74802-0849
Phone (405) 273-5801

Other names 1

  • Venkata Rama Gopala Sriharsha Damera Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20130917000522 OK Practitioner - Nephrology 5294979076 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

1102 W Macarthur St
Shawnee, OK 74804-1743
Phone (405) 273-2270

2401 W Wrangler Blvd
Seminole, OK 74868-1917
Phone (405) 382-3650

3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801

608 NW 9TH St
Oklahoma City, OK 73102-1049

Hospital & facility affiliations

  • Fmcna - Shawnee Dialysis facility, Shawnee, OK, CCN 372533
  • DaVita Shawnee Dialysis Center Dialysis facility, Shawnee, OK, CCN 372513
  • Sanderling Dialysis Center of Holdenville Dialysis facility, Holdenville, OK, CCN 372589
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149
  • SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037
  • Holdenville General Hospital Hospital, Holdenville, OK, CCN 371321
  • SSM Health St Anthony Hospital - Midwest Hospital, Midwest City, OK, CCN 370094
  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028

Merit-based Incentive Payment System (MIPS)

Final score
84.48 of 100Reported as group
Quality
81.18
Promoting interoperability
93
Improvement activities
40
Cost
72.93

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
80.43
Promoting interoperability
100
Improvement activities
40
Cost
72.76

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28396OKMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC Internal Medicine CurrentSince May 14, 2022 Accepting new patients
SSM Health Care of Oklahoma, Inc Current Accepting new patients
Saints Medical Group, LLC CurrentSince May 14, 2022 Accepting new patients
St Anthony Shawnee Hospital Inc Past Accepting new patients

Locations

7106 Solutions Ctr
Chicago, IL 60677

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

2129 SW 59th St
Oklahoma City, OK 73119
Phone (405) 680-2270

3315 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801

Interoperability endpoints

  • Direct secure messaging: vdamera86383@direct-ehr-ssmhc.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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1861646358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748020849",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748049638",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMERA",
        "first_name": "VENKATA RAMA GOPALA",
        "middle_name": "SRIHARSHA",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "28396",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "28396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VENKATA RAMA",
            "last_name": "GOPALA SRIHARSHA DAMERA",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.