LAVANYA BODDU (NPI# 1851503833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851503833 |
| Entity Type | Individual |
| Full Name | LAVANYA BODDU |
| Credential | MD |
| Practice Address |
1836 S Macarthur Blvd Springfield IL 62704-4030 |
| Practice Telephone | 2177891403 |
| Practice Fax Number | 2177891825 |
| Mailing Telephone | 2177891403 |
| Mailing Fax Number | 2177891825 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-06-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 036-121313 | IL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 036121313 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036121313-1 | 05 | |
| IL | BLUE SHIELD | 036121313 | 01 |
| Street Address |
1836 S MACARTHUR BLVD |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704-4030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003889411 | Winston J Townsend | Internal Medicine | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2006-02-08 |
| 1912542051 | Stephanie A Olsen | Nurse Practitioner | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2019-11-13 |
| 1699317081 | Michael Mcpeak | Specialist/Technologist | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2019-10-17 |
| 1598205601 | Nichole Mcmillen | Nurse Practitioner | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2017-03-08 |
| 1952846016 | Megan Adams | Nurse Practitioner | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2016-12-28 |
| 1225415664 | Anne Lunt Hocking | Nurse Practitioner | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2015-05-06 |
| 1720479405 | Christina Skaar | Physician Assistant | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2015-02-17 |
| 1740545441 | Maria Khattak | Family Medicine | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2012-07-09 |
| 1598911281 | Shabaz Gill | Family Medicine | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2008-08-13 |
| 1164612669 | Wendy D Dorworth | Nurse Practitioner | 1836 S Macarthur Blvd, Springfield, IL 62704-4030 | 2007-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1841802592 | Community Health and Wellness Services, Inc. | Family Medicine | 312 Memorial Park Dr, Springfield, PA 19064-1714 | 2020-08-22 |
| 1649815796 | 180 Health Lifestyle Wellness Centers | Family Medicine | 1936 S Glenstone Ave, Springfield, MO 65804-2305 | 2019-11-13 |
| 1790337988 | Aminat Ogun | Family Medicine | 520 N 4th St # 62702, Springfield, IL 62702-5238 | 2019-07-09 |
| 1770076622 | Thomas John Schumann | Family Medicine | 1260 E. Woodlawn Ave, Suite 200, Springfield, PA 19064-3988 | 2018-06-14 |
| 1134648959 | Patricia Derges | Family Medicine | 3259 E Sunshine St Ste Aa, Springfield, MO 65804-2114 | 2017-09-12 |
| 1740704667 | Mercy Management of Sepa | Family Medicine | 1001 Baltimore Pike Ste 109, Springfield, PA 19064-2852 | 2017-08-02 |
| 1083134902 | Trevor Conner | Family Medicine | 1423 N Jefferson Ave, B100, Springfield, MO 65802 | 2017-06-21 |
| 1790215853 | Vincent Marchese | Family Medicine | 1260 E Woodland Ave Ste 200, Springfield, PA 19064-3956 | 2017-06-12 |
| 1184152100 | Canaan Arceneaux | Family Medicine | 1001 Baltimore Pike Ste 106, Springfield, PA 19064-2800 | 2017-06-03 |
| 1063943587 | Cody Stark Rogers | Family Medicine | 1423 N Jefferson Ave # A100, Springfield, MO 65802-1988 | 2017-03-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
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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.