Individual ProviderSudha Bogineni-MisraRadiologyAllopathic & Osteopathic PhysiciansPractice Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252(904) 399-5550PECOS EnrollmentBased on the most recent information from CMS, provider Sudha Bogineni-Misra is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1922068956Provider TypeIndividualFull NameBogineni-Misra, SudhaCredentialMDGenderFemaleSole ProprietorNoEnumeration Date3/24/2006Last Updated8/21/2017Contact InformationPractice LocationPractice Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252Phone(904) 399-5550Fax(904) 346-4334Mailing LocationMailing Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252Phone(904) 399-5550Fax(904) 346-4334Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseME73331FloridaProvider IdentifiersIDDescriptionIssuerID00775123ADescriptionMedicaidIssuerUnlistedGeorgiaID252390600DescriptionMedicaidIssuerUnlistedFloridaID41860DescriptionOtherIssuerBCBSFlorida