Active NPI
Kalyan Chakravarthy Potu, M.D.
- Cardiovascular Disease Physician
- Woodland, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- C193021
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| C193021 | CA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proctor Health Systems | Current | Accepting new patients | |
| Methodist Medical Center of Illinois | Current | Accepting new patients | |
| Pocatello Health Services, LLC | Current | Accepting new patients | |
| Dignity Health Medical Foundation | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Current | Accepting new patients | |
| Pocatello Health Services, LLC | Current | Accepting new patients | |
| Methodist Medical Center of Illinois | Internal Medicine | Current | Accepting new patients |
| Dignity Health Medical Foundation | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Methodist Medical Center of Illinois | Current | Accepting new patients | |
| Proctor Health Systems | Current | Accepting new patients | |
| Proctor Health Systems | Internal Medicine | Current | Accepting new patients |
| Pocatello Health Services, LLC | Current | Accepting new patients | |
| Dignity Health Medical Foundation | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Internal Medicine | Current | Accepting new patients |
| Board of Trustees of Southern Illinois University | Current | 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
- 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.
-
- Multi-Specialty Clinic/Center
- Sacramento, CA
- NPI 1700803418
-
- Primary Care Clinic/Center
- Springfield, IL
- NPI 1396097960
-
- Rehabilitation Hospital Unit
- Peoria, IL
- NPI 1982656575
-
- Endocrinology, Diabetes & Metabolism Physician
- Springfield, IL
- NPI 1558385989
Internal Medicine
-
- Multi-Specialty Clinic/Center
- Woodland, CA
- NPI 1144497678
-
- Multi-Specialty Clinic/Center
- Redding, CA
- NPI 1912288432
-
- Federally Qualified Health Center (FQHC)
- Carbondale, IL
- NPI 1568210425
-
- Primary Care Clinic/Center
- Springfield, IL
- NPI 1922350099
-
- General Acute Care Hospital
- Peoria, IL
- NPI 1164474755
-
- Family Medicine Physician
- Peoria, IL
- NPI 1184670663
Internal Medicine
-
- Durable Medical Equipment & Medical Supplies
- Pocatello, ID
- NPI 1154089126
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Woodland, CA
- NPI 1922116037
-
- General Acute Care Hospital
- Sacramento, CA
- NPI 1487694857
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; 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.