Active NPI
Prashanthi Bora Koduri, M.D.
- Family Medicine Physician
- Suffolk, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 101229036
- Practice address
- 3920 Bridge Rd
BLDG a, Ste. 207
Suffolk, VA 23435-1117 - Phone
- (757) 983-2200
- Fax
- (757) 923-2201
- NPI assigned
- May 9, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 101229036 | VA | Primary |
Addresses
Primary practice location
3920 Bridge Rd
BLDG a, Ste. 207
Suffolk, VA 23435-1117
Mailing address
3920 Bridge Rd
BLDG a, Ste. 207
Suffolk, VA 23435-1117
Phone (757) 983-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10048061 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3920 A Bridge Rd
Suite 202
Suffolk, VA 23435-1107
Phone (757) 736-3725
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101229036 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sentara Medical Group | Family Medicine | Current | Accepting new patients |
Locations
850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162
919 S Church St
Smithfield, VA 23430
Phone (757) 357-3291
3920A Bridge Rd
Ste 202
Suffolk, VA 23435
Phone (757) 736-3725
3920A Bridge Rd
Ste 207
Suffolk, VA 23435
Phone (757) 983-2200
2000 Meade Pkwy
Suffolk, VA 23434
Phone (757) 539-0251
3920 Bridge Rd
#A207
Suffolk, VA 23435
3920 Bridge Rd
Ste 207
Suffolk, VA 23435
Phone (757) 983-2200
Interoperability endpoints
- pkoduri25550@direct.sentara.net
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Norfolk, VA
- NPI 1265485270
Hospital & facility affiliations 15
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Suffolk, VA
- NPI 1104658434
-
- General Acute Care Hospital
- Portsmouth, VA
- NPI 1750399192
-
- Home Health Agency
- Suffolk, VA
- NPI 1174060214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575590400000",
"number": "1891744603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 BRIDGE RD",
"address_2": "BLDG A, STE. 207",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234351117",
"telephone_number": "757-983-2200",
"fax_number": "757-923-2201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 BRIDGE RD",
"address_2": "BLDG A, STE. 207",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234351117",
"telephone_number": "757-983-2200",
"fax_number": "757-923-2201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODURI",
"first_name": "PRASHANTHI",
"middle_name": "BORA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-09",
"last_updated": "2019-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "101229036",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10048061",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.