DR. MADHU KANDARPA MD
NPI 1891999413
Internal Medicine - Nephrology in Kettering, OH

NPI Status: Active since June 14, 2007

Contact Information

1362 E STROOP RD
KETTERING, OH
ZIP 45429
Phone: (937) 643-0015
Fax: (937) 643-0016

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 33
Internal Medicine
Nephrology
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About MADHU KANDARPA

This page provides the complete NPI Profile along with additional information for Madhu Kandarpa, an internist established in Kettering, Ohio with a medical specialization in Internal Medicine, focusing in nephrology and more than 33 years of experience. The healthcare provider is registered in the NPI registry with number 1891999413 assigned on June 2007. The practitioner's primary taxonomy code is 207RN0300X with license number 094294 (OH). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI: 1891999413
Provider Name: DR. MADHU KANDARPA MD
Gender: Male
Entity Type: Individual
Location Address: 1362 E STROOP RD KETTERING, OH 45429
Location Phone: (937) 643-0015
Location Fax: (937) 643-0016
Mailing Address: 1362 E STROOP RD KETTERING, OH 45429
Mailing Phone: (937) 643-0015
Mailing Fax: (937) 643-0016
Medical School Name: OTHER
Graduation Year: 1993
Is Sole Proprietor?: No
Enumeration Date: 06-14-2007
Last Update Date: 12-13-2012
Code Navigator

An internist like Madhu Kandarpa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Internal Medicine Nephrology
Taxonomy Code: 207RN0300X
Type: Allopathic & Osteopathic Physicians
License No.: 094294
License State: OH
Taxonomy Description: An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Buckeye Health Plan

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Clear Gold - HMO
Clear Gold + Vision + Adult Dental - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Silver - HMO
Complete Silver + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO

Ambetter from Meridian

Clear Silver - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO
Standard Silver + Vision + Adult Dental - HMO

Ambetter Health

Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO
Standard Silver + Vision + Adult Dental - HMO

CareSource

Bronze 7500 $25 Generic Drugs - HMO
Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness - HMO
Core Gold 1500 $10 Generic Drugs - HMO
Core Gold 1500 $10 Generic Drugs + Adult Vision & Fitness - HMO
Diabetes Gold 3000 $0 Chronic Care Drugs & Services - HMO
Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
Diabetes Silver 5000 $0 Chronic Care Drugs & Services - HMO
Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
Gold 2000 $15 Generic Drugs - HMO
Gold 2000 $15 Generic Drugs + Adult Vision & Fitness - HMO

Molina Healthcare

Molina Bronze Enhanced 3500 - HMO
Molina Bronze Enhanced 3500 Plus with Adult Dental and Vision - HMO
Molina Bronze Enhanced 3500 Plus with Adult Vision - HMO
Molina Bronze Saver 7000 - HMO
Molina Bronze Saver 7000 Plus with Adult Dental and Vision - HMO
Molina Bronze Saver 7000 Plus with Adult Vision - HMO
Molina Bronze Smart Heart Health - HMO
Molina Bronze Standard - HMO
Molina Gold Core 1640 - HMO
Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO

Oscar Health Insurance

Bronze Classic 4700 - HMO
Bronze Classic Standard - HMO
Bronze Elite + PCP Saver Plus - HMO
Bronze Simple Breathe Easy with Enhanced COPD Benefits - HMO
Bronze Simple Chronic Care CKM - HMO
Bronze Simple Diabetes - HMO
Gold Classic - HMO
Gold Classic Standard - HMO
Gold Elite Saver Plus - HMO
Silver Classic Standard - HMO

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Standard (No Referrals) - HMO
UHC Bronze Standard+ (Dental + Vision, No Referrals) - HMO
UHC Gold Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) - HMO
UHC Gold Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
UHC Gold Standard (No Referrals) - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
4280861	MEDICARE PIN (08)	OH
3015749	MEDICAID (05)	OH

Medicare Participation & PECOS Enrollment Status

Madhu Kandarpa is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Madhu Kandarpa is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 345322533
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20100105000029, I20240118004356
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
Dialysis services, 1 physician visit per month (20 years or older)
Dialysis services, 2-3 physician visits per month (20 years or older)
Dialysis services, 4 or more physician visits per month (20 years or older)
Established patient office or other outpatient visit, 30-39 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Hemodialysis procedure requiring repeated evaluation
Hemodialysis procedure with physician evaluation
Initial hospital inpatient care per day, typically 70 minutes
Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes
Management using the results of remote vital sign monitoring per calendar month, first 20 minutes
New patient office or other outpatient visit, 45-59 minutes
Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.53 for a new patient copayment and $24.11 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 45429 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $126.12
Minimum New Patient Price $54.34
Maximum New Patient Price $166.65

Average New Patient Copayment $31.53
Minimum New Patient Copayment $13.58
Maximum New Patient Copayment $41.66

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $96.44
Minimum Established Patient Price $17.1
Maximum Established Patient Price $135.4

Average Established Patient Copayment $24.11
Minimum Established Patient Copayment $4.27
Maximum Established Patient Copayment $33.85

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Annual registration in the Prescription Drug Monitoring Program	Yes	N/A
Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months.
Consultation of the Prescription Drug Monitoring Program	Yes	N/A
Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance.
Diabetes: Medical Attention for Nephropathy	99%	205
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record	100%	1246
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
Engagement of New Medicaid Patients and Follow-up	Yes	N/A
Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare. A timely manner is defined as within 10 business days for this activity.
Engagement of patients through implementation of improvements in patient portal	Yes	N/A
Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence.
e-Prescribing	99%	310
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	100%	20
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Implementation of condition-specific chronic disease self-management support programs	Yes	N/A
Provide condition-specific chronic disease self-management support programs or coaching or link patients to those programs in the community.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes	Yes	N/A
Ensure full engagement of clinical and administrative leadership in practice improvement that could include one or more of the following: Make responsibility for guidance of practice change a component of clinical and administrative leadership roles; Allocate time for clinical and administrative leadership for practice improvement efforts, including participation in regular team meetings; and/or Incorporate population health, quality and patient experience metrics in regular reviews of practice performance.
Patient-Specific Education	9%	807
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Pneumococcal Vaccination Status for Older Adults	80%	433
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	18%	679
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Influenza Immunization	58%	575
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	86%	21
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide Education Opportunities for New Clinicians	Yes	N/A
MIPS eligible clinicians acting as a preceptor for clinicians-in-training (such as medical residents/fellows, medical students, physician assistants, nurse practitioners, or clinical nurse specialists) and accepting such clinicians for clinical rotations in community practices in small, underserved, or rural areas.
Provide Patient Access	76%	807
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	0%	807
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Use of High-Risk Medications in the Elderly	0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	433
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Madhu Kandarpa is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type
PIKEVILLE MEDICAL CENTER	911 BYPASS ROAD PIKEVILLE, KY 41501	(606) 430-3500	Acute Care Hospitals
KETTERING HEALTH GREENE MEMORIAL	1141 NORTH MONROE DRIVE XENIA, OH 45385	(937) 352-2000	Acute Care Hospitals
KETTERING HEALTH MAIN CAMPUS	3535 SOUTHERN BOULEVARD KETTERING, OH 45429	(937) 395-8165	Acute Care Hospitals
KETTERING HEALTH DAYTON	405 GRAND AVENUE DAYTON, OH 45405	(937) 723-3410	Acute Care Hospitals
SOIN MEDICAL CENTER	3535 PENTAGON PARK BLVD BEAVER CREEK, OH 45431	(937) 702-4000	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1891999413, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 77. The final step is to find the difference between that total and the next multiple of ten (80 - 77 = 3).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 18 → 1 + 8

Pos 4

Unchanged

Pos 5

Doubled → 18 → 1 + 8

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 2

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 9 → 18 → 9 9 → 18 → 9 9 → 18 → 9 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 1 + 8 + 1 + 1 + 8 + 9 + 1 + 8 + 4 + 2 + 24 = 77

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 77 is 80. The difference is the calculated check digit.

80 - 77 = 3

This NPI is valid

The calculated check digit is 3, which matches the last digit of 1891999413.