Individual provider Active NPI

Shivaprakash T Kudlapur, MD

  • Internal Medicine Physician
  • Logan, OH
National Provider Identifier
1891780326
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35065974K Issued in OH
Practice address
30381 Chieftain Dr
Logan, OH 43138-9092
Phone
(740) 385-2555
Fax
(740) 380-3750
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

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 35065974K OH Primary

Addresses

Primary practice location

30381 Chieftain Dr
Logan, OH 43138-9092

Mailing address

PO Box 188
Chillicothe, OH 45601-0188
Phone (740) 773-4366

Other identifiers 13

IdentifierTypeStateIssuer
0965728MedicaidOH
311155352OtherE V BENEFITS
311155352OtherOHOHIO HEALTH CHOICE
311155352OtherAETNA
P00084899OtherRAILROAD MEDICARE
0408409OtherUNITED HEALTHCARE
311155352OtherCIGNA/CONN GENERAL
311155352OtherPPO NEXT
311155352OtherTRICARE
311155352OtherCENTRAL BENEFITS
000000300069OtherOHANTHEM
311155352OtherEMERALD HEALTH
311155352OtherGREAT WEST

Other names 1

  • Prakash T Kudlapur Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040128000609 OH Practitioner - Internal Medicine 0042113037 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hopewell Health Centers, Inc.Group PAC ID 9234049990, 55 clinicians

Practice addresses (Care Compare)

1049 Western Ave
Chillicothe, OH 45601-1104
Phone (740) 773-4366

30381 Chieftain Dr
Logan, OH 43138-9092
Phone (740) 385-2555

Hospital & facility affiliations

  • Caretenders Vna Home health agency, Lancaster, OH, CCN 367137
  • Hocking Valley Community Hospital Hospital, Logan, OH, CCN 361330
  • Fairfield Medical Center Hospital, Lancaster, OH, CCN 360072

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hopewell Health Centers Inc Current Accepting new patients
Hopewell Health Centers Inc CurrentSince Mar 1, 2019 Accepting new patients
Hocking Valley Medical Group Transportation Past Accepting new patients

Locations

90 Hospital Dr
Athens, OH 45701
Phone (740) 592-3091

1049 Western Ave
Chillicothe, OH 45601
Phone (740) 773-1006

601 State Route 664 N
Logan, OH 43138
Phone (740) 380-8000

Organizations & group practices 3

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 3

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": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1891780326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456010188",
            "telephone_number": "740-773-4366",
            "fax_number": "740-775-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30381 CHIEFTAIN DR",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431389092",
            "telephone_number": "740-385-2555",
            "fax_number": "740-380-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLAPUR",
        "first_name": "SHIVAPRAKASH",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35065974K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0965728",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "E V  BENEFITS",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO HEALTH CHOICE",
            "identifier": "311155352",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00084899",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0408409",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA/CONN GENERAL",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO  NEXT",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTRAL BENEFITS",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000300069",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMERALD HEALTH",
            "identifier": "311155352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST",
            "identifier": "311155352",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRAKASH",
            "last_name": "KUDLAPUR",
            "middle_name": "T",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Logan, OH

Sources for this page

Verify at the official NPI Registry.