Individual provider Active NPI

Anitha Gaddam, MD

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1932363876
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
44481 Issued in AZ
Practice address
635 East Baseline Road
Phoenix, AZ 85042
Phone
(602) 243-7277
Fax
(602) 243-1235
NPI assigned
Jul 10, 2008
Last updated
Aug 7, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 44481 AZ Primary

Addresses

Primary practice location

635 East Baseline Road
Phoenix, AZ 85042

Mailing address

2702 North 3Rd Street
4020
Phoenix, AZ 85004
Phone (602) 323-3344

Other identifiers 1

IdentifierTypeStateIssuer
715337MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20121017000183 AZ Practitioner - Internal Medicine 9638329253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Park Health CenterGroup PAC ID 8325949647, 117 clinicians

Practice addresses (Care Compare)

635 E Baseline Rd
Phoenix, AZ 85042-6551
Phone (602) 243-7277

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Hospitalists, PLLC Internal Medicine CurrentSince Dec 1, 2015 Accepting new patients
Mountain Park Health Center CurrentSince Aug 2, 2012 Accepting new patients
Mountain Park Health Center CurrentSince Aug 2, 2012 Accepting new patients
Mountain Park Health Center Past Accepting new patients
Mountain Park Health Center Past Accepting new patients
Mountain Park Health Center - Dental Past Accepting new patients
Pioneer Medical Group PLLC Internal Medicine Past Accepting new patients

Locations

3115 S Price Rd
Chandler, AZ 85248
Phone (480) 855-4011

140 N Litchfield Rd
Ste 200
Goodyear, AZ 85338
Phone (602) 640-3550

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492

635 E Baseline Rd
Phoenix, AZ 85042

6601 W Thomas Rd
Phoenix, AZ 85033

690 N Cofco Center Ct
Ste 230
Phoenix, AZ 85008

1492 S Mill Ave
Ste 312
Tempe, AZ 85281
Phone (480) 921-1100

Organizations & group practices 7

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375833600000",
    "number": "1932363876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 NORTH 3RD STREET",
            "address_2": "4020",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85004",
            "telephone_number": "602-323-3344",
            "fax_number": "602-323-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 EAST BASELINE ROAD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85042",
            "telephone_number": "602-243-7277",
            "fax_number": "602-243-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDAM",
        "first_name": "ANITHA",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2013-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "44481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "715337",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.