Krishnamraju Kosuru, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2015040888 Issued in MO

Practice address

3126 S Jackson Ave
Suite 100
Joplin, MO 64804-2534

Phone

(417) 556-3416

Fax

(417) 556-3417

NPI assigned

Jul 7, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO, AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkosuru701829@directb.mercy.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1407191216
  Medicare reassignment NPD
• Mercy Clinic Joplin LLC

  • Family Medicine Physician
  • Joplin, MO
  • NPI 1215264817
  Medicare reassignment
• Banner Hospital Based Physicians Arizona LLC

  • Multi-Specialty Clinic/Center
  • San Tan Valley, AZ
  • NPI 1275889891
  Medicare reassignment
• Banner Physician Super Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1841573870
  Medicare reassignment
• Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1285278077
  NPD
• Banner Hospital Based Physicians Arizona LLC

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1124374822
  NPD
• Banner Hospital Based Physicians Arizona LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Phoenix, AZ
  • NPI 1780445171
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1013204296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504944",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631504944",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3126 S JACKSON AVE",
            "address_2": "SUITE 100",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042534",
            "telephone_number": "417-556-3416",
            "fax_number": "417-556-3417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSURU",
        "first_name": "KRISHNAMRAJU",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-07",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2015040888",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "0437804",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200622340A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013204296",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Michelle Konopka
• Jack Anthony Konrade
• Dominik John Kosican
• Alaina C Kostella
• Braedon Porter Kosten
• Matthew Krahl
• Amy R Kralik, RN
• Kristopher Lowry LLC
• Roi Kent Krokower
• Rebecca Ann Kropf, OTRL

• Pediatrics Physician in Joplin, MO
• Providers in Joplin, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.