Individual provider Active NPI

Kalyan Chakravarthy Potu, M.D.

  • Cardiovascular Disease Physician
  • Woodland, CA
National Provider Identifier
1861834897
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
C193021 Issued in CA
Practice address
632 W Gibson Rd
Woodland, CA 95695-5169
Phone
(530) 668-2600
Fax
(530) 669-5439
NPI assigned
Jul 18, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X C193021 CA Primary

Addresses

Primary practice location

632 W Gibson Rd
Woodland, CA 95695-5169

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, ID, CA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20191213001345 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8527297704 Reassigns benefits to 4 organizations
I20231215001644 ID Practitioner - Cardiovascular Disease (Cardiology) 8527297704
I20240711001991 CA Practitioner - Cardiovascular Disease (Cardiology) 8527297704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

632 W Gibson Rd
Woodland, CA 95695-5169
Phone (530) 668-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C193021CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proctor Health Systems CurrentSince Sep 25, 2022 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Sep 25, 2022 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Dignity Health Medical Foundation CurrentSince Jun 23, 2024 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 5, 2019 Accepting new patients
Pocatello Health Services, LLC CurrentSince Nov 13, 2023 Accepting new patients
Methodist Medical Center of Illinois Internal Medicine CurrentSince Sep 25, 2022 Accepting new patients
Dignity Health Medical Foundation Current Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Nov 13, 2019 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Proctor Health Systems CurrentSince Sep 25, 2022 Accepting new patients
Proctor Health Systems Internal Medicine Current Accepting new patients
Pocatello Health Services, LLC CurrentSince Nov 13, 2023 Accepting new patients
Dignity Health Medical Foundation CurrentSince Jun 23, 2024 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc Internal Medicine CurrentSince Nov 5, 2019 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Nov 13, 2019 Accepting new patients
St Johns Hospital of the Hospital Sisters of the Third Order of St F Past Accepting new patients
Memorial Medical Center Past Accepting new patients
Dignity Community Care Cardiovascular Disease Past Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

632 W Gibson Rd
Woodland, CA 95695
Phone (530) 666-1631

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

5401 N Knoxville Ave
Ste 204
Peoria, IL 61614
Phone (309) 683-1200

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

815 Main St
Ste A1
Peoria, IL 61602

747 N Rutledge St
Springfield, IL 62702
Phone (217) 545-6112

747 N Rutledge St
Fl 5
Springfield, IL 62702
Phone (217) 545-3262

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: kpotu889923@ahs.direct-ci.com

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 2

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": "1374105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1861834897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 W GIBSON RD",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956955169",
            "telephone_number": "530-668-2600",
            "fax_number": "530-669-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTU",
        "first_name": "KALYAN",
        "middle_name": "CHAKRAVARTHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-18",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "C193021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland, CA

Sources for this page

Verify at the official NPI Registry.