Jagannadharao Brahmamdam, MD is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Danville, Illinois. His current practice location is
812 N Logan Ave, Danville, Illinois. You can reach out to his office (for appointments etc.) via phone at
(217) 431-8413.
Jagannadharao Brahmamdam is licensed to practice in Illinois (license number 03606004) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1457386922.
Physician's Profile
| Full Name | Jagannadharao Brahmamdam |
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| Gender | Male |
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| Speciality | Radiology - Diagnostic Radiology |
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| Location | 812 N Logan Ave, Danville, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1457386922
- Provider Enumeration Date: 07/12/2006
- Last Update Date: 10/12/2012
Medicare PECOS Information:
- PECOS PAC ID: 8729078373
- Enrollment ID: I20070718000672
Medical Identifiers
Medical identifiers for Jagannadharao Brahmamdam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1457386922 | NPI | - | NPPES |
| 0360600041 | Medicaid | IL | |
| 200108180 | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 2085R0202X | Radiology - Diagnostic Radiology | 03606004 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jagannadharao Brahmamdam allows following entities to bill medicare on his behalf.
| Entity Name | East Central Illinois Radiology Associates Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912277443 PECOS PAC ID: 3870750482 Enrollment ID: O20120209000712 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jagannadharao Brahmamdam is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Jagannadharao Brahmamdam, MD 812 N Logan Ave, Danville, IL 61832-3752 Ph: (217) 431-8413 | Jagannadharao Brahmamdam, MD 812 N Logan Ave, Danville, IL 61832-3752 Ph: (217) 431-8413 |
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