Divya Koduri, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

RS2022-0787 Issued in NM

Practice address

2539 Medical Dr Ste 105
Alamogordo, NM 88310-8720

Phone

(508) 471-7499

NPI assigned

Mar 31, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Family Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Honorhealth Medical Group, LLCGroup PAC ID 1557274057, 338 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Honorhealth Scottsdale Shea Medical Center Hospital, Scottsdale, AZ, CCN 030087

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dkoduri646400@direct.honorhealth.com
• Direct secure messaging: divya.koduri.1@19849.direct.athenahealth.com

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.

• Honorhealth Medical Group, LLC

  • Primary Care Clinic/Center
  • Peoria, AZ
  • NPI 1043851793
  Medicare reassignment Care Compare group NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1285338343
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1861530222
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1679876601
  NPD (past)
• Honorhealth Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1700423415
  NPD (past)
• Honorhealth Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1740273614

  Family Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Honorhealth

  • General Acute Care Hospital
  • Scottsdale, AZ
  • NPI 1386608859
  Care Compare affiliation

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

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1932849429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2539 MEDICAL DR STE 105",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883108720",
            "telephone_number": "508-471-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2539 MEDICAL DR STE 105",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883108720",
            "telephone_number": "508-471-7499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 S Telshor Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880115069",
            "country_code": "US",
            "telephone_number": "575-522-8641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KODURI",
        "first_name": "DIVYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-31",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": "RS2022-0787",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "RS2022-0787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Joseph Klump, DDS
• John Paul Klump, D.D.S. M.S.
• Julia Kaye Knauff, FNP
• Manji Knudson
• Danielle Denae Knutt, RD LD
• Uchechukwu Genevieve Komolafe, DNP
• Stefan Korec, M.D.
• Kristi K Kotrous, FSS
• Chris Kotter, M.P.T.
• Shanleigh Kouba

• Family Medicine Physician in Alamogordo, NM
• Providers in Alamogordo, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; 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.

Verify at the official NPI Registry.