NPIMap

Individual provider Active NPI

Anuradha Kollipara, M.D

  • Internal Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1871523787
Registry record updated Jan 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01046950 Issued in IN
Practice address
7972 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone
(260) 436-0281
Fax
(260) 459-2779
NPI assigned
Jul 4, 2006
Last updated
Jan 10, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01046950 IN Primary

Addresses

Primary practice location

7972 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Mailing address

7972 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 436-0281

Other identifiers 3

IdentifierTypeStateIssuer
110212244OtherRAILROAD MEDICARE
000000093479OtherBLUE CROSS BLUE SHIELD
200197730MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20090414000017 IN Practitioner - Internal Medicine 9335296193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Srisai P CGroup PAC ID 8325195944, 2 clinicians

Practice addresses (Care Compare)

7972 W Jefferson Blvd
Suite a
Fort Wayne, IN 46804-4140
Phone (260) 459-1780

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
33.88 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
76.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01046950INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Srisai P C Internal Medicine CurrentSince Apr 12, 1999 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

7972 W Jefferson Blvd
Ste A
Fort Wayne, IN 46804
Phone (260) 436-0281

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294617600000",
    "number": "1871523787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7972 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-0281",
            "fax_number": "260-459-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7972 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-436-0281",
            "fax_number": "260-459-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLIPARA",
        "first_name": "ANURADHA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2011-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01046950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110212244",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000093479",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200197730",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.