Individual provider Active NPI

Prabash Koneru, M.D.

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1033306204
Registry record updated Jul 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
250331 Issued in NY
Practice address
721 Flushing Ave
Brooklyn, NY 11206
Phone
(347) 671-7575
NPI assigned
Oct 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 250331 NY Primary

Addresses

Primary practice location

721 Flushing Ave
Brooklyn, NY 11206

Mailing address

2114 Pacific Blvd
Atlantic Beach, NY 11509
Phone (347) 276-8866

Other practice location 1

800 Poly Pl
Brooklyn, NY 11209-7104
Phone (718) 836-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 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

Enrollment IDStateProvider typePAC IDDetails
I20110322000318 NY Practitioner - Internal Medicine 1658554191 Reassigns benefits to 1 organization
I20181001002977 NJ Practitioner - Internal Medicine 1658554191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

17121 Jamaica Ave
Jamaica, NY 11432-5427
Phone (718) 521-4442

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Freeway Psychiatry PC CurrentSince Aug 3, 2022 Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine Past Accepting new patients
Brooklyn United Methodist Church Home Past Accepting new patients

Locations

9225 Kennedy Blvd
#F
North Bergen, NJ 07047
Phone (201) 500-9755

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: pkoneru1053771@nychhc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530662400000",
    "number": "1033306204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 PACIFIC BLVD",
            "city": "ATLANTIC BEACH",
            "state": "NY",
            "postal_code": "11509",
            "telephone_number": "347-276-8866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 FLUSHING AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11206",
            "telephone_number": "347-671-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Poly Pl",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112097104",
            "country_code": "US",
            "telephone_number": "718-836-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONERU",
        "first_name": "PRABASH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-01",
        "last_updated": "2018-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "250331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.