DR. PAVAN KUMAR BHAMIDIPATI (NPI# 1548490840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548490840 |
| Entity Type | Individual |
| Full Name | DR. PAVAN KUMAR BHAMIDIPATI |
| Credential | MD |
| Practice Address |
1406 6th Ave N Saint Cloud MN 56303 |
| Mailing Address |
1406 6th Ave N Saint Cloud MN 56303-1900 |
| Practice Telephone | 3022294907 |
| Practice Fax Number | 3022295160 |
| Mailing Telephone | 3022294907 |
| Mailing Fax Number | 3022295160 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2018-05-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
63587 | MN | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
2012019678 | MO | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | 2012019678 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Barnes Jewish Hospital Plz, Saint Louis, MO 631101003 | 3143621700 | 3143629878 |
| Street Address |
1406 6TH AVE N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336149939 | Ralph E Fedor | Radiology | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2005-07-26 |
| 1558962399 | Amanda Lee King | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-11-06 |
| 1912512302 | Fadumo Hassan | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-09-11 |
| 1083228092 | Kristin Deneille Hazeman | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1901 | 2020-09-07 |
| 1508477845 | Taylor Dean Olson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1407467749 | Traci Jo Salveson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1487264164 | Cameron Charles Hendrickson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-06 |
| 1154931475 | Megan Ann Brown | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-01 |
| 1326657255 | Amanda J Dircks | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-07-27 |
| 1003439241 | Mary Elizabeth Amundson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134105265 | Donald James Jurgens | Internal Medicine | 1900 Centracare Cir, Centracare Clinic Health Plaza Specialties, Saint Cloud, MN 56303-5000 | 2005-12-20 |
| 1871584557 | Nicholas F Reuter | Internal Medicine | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2005-11-02 |
| 1093706954 | Harold E Windschitl | Internal Medicine | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2005-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780041301 | Nicole Jacobi | Internal Medicine | 701 Park Avenue Mail Code O1.340, Minneapolis, MN 55415-1623 | 2016-01-27 |
| 1366691636 | Laxmidas Anant Sawkar | Internal Medicine | 11376 Sandcastle Dr, Woodbury, MN 55129-8562 | 2008-09-11 |
| 1669628517 | Howard Clark Hoagland | Internal Medicine | 1705 Folwell Dr Sw, Rochester, MN 55902-0987 | 2008-08-12 |
| 1366626343 | Hilary Ikenna Ufearo | Internal Medicine | 1900 Centracare Circle, #1600, Centracare Clinic Health Plaza Specialties/oncology, St Cloud, MN 56303-5000 | 2007-12-26 |
| 1598851198 | Douglas Yee | Internal Medicine | Masonic Cancer Center, First Floor, Suite M100, 424 Harvard Street Se, Minneapolis, MN 55455 | 2006-10-04 |
| 1073605952 | John Manion | Internal Medicine | 3435 West Broadway, Suite 1065, Robbinsdale, MN 55422 | 2006-09-29 |
| 1194817072 | Robert D Winston | Internal Medicine | 3960 Coon Rapids Blvd, Suite 311, Coon Rapids, MN 55433 | 2006-09-29 |
| 1023111531 | Ayse Malcolm | Internal Medicine | 1455 St. Francis Avenue, St. Francis Regional Medical Center, Shakopee, MN 55379-3380 | 2006-09-07 |
| 1821008996 | Joseph Michael Cardamone Jr. | Internal Medicine | 11850 Blackfoot Ne, Suite 100, Coon Rapids, MN 55433-2598 | 2006-08-09 |
| 1134135106 | Kendra L. Kubiak | Internal Medicine | 3931 Louisiana Avenue, St Louis Park, MN 55426 | 2006-07-31 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.