Kavantissa Monarawila Keppetipola, MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

113510 Issued in GA

Practice address

1315 Jesse Jewell Pkwy NE Ste 300
Gainesville, GA 30501-3875

Phone

(770) 219-9678

NPI assigned

Mar 6, 2019

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

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Specialty

Neurosurgery

Education

Rush Medical College of Rush University, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riddle Memorial Hospital Hospital, Media, PA, CCN 390222

Medicare enrollment (NPD)

Enrolled

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riddle Memorial Hospital

  • General Acute Care Hospital
  • Media, PA
  • NPI 1407856099
  Care Compare affiliation

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1013475201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 JESSE JEWELL PKWY NE STE 300",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013875",
            "telephone_number": "770-219-9678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 S Paulina St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123806",
            "country_code": "US",
            "telephone_number": "312-942-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEPPETIPOLA",
        "first_name": "KAVANTISSA",
        "middle_name": "MONARAWILA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-06",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "113510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Frobos Kemp, NP-C
• Gary Kempler, MD
• Kristi A Kennedy, CPNP
• Kenneth E. Goolsby, MD & Associates, PC
• Genevieve Kennett, CCC-SLP
• Allan Kerandi, MD
• Jonathan G. Kerrick, MD
• Kim Kerrick, PT
• Rebekah Ellen Mellor Ketterman
• Key Optique, LLC

• Neurological Surgery Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Neurological Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.