NPIMap

Organization Active NPI

Kandaswamy Jayaraj MD PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Beaumont, TX
National Provider Identifier
1043218514
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
L6963 Issued in TX
Legal business name
KANDASWAMY JAYARAJ MD PA
Practice address
3030 North St
#310
Beaumont, TX 77702-1433
Phone
(409) 892-2111
Fax
(409) 892-2173
NPI assigned
Jul 8, 2005
Last updated
Nov 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Authorized official

Name
Mr. Kandaswamy Jayaraj, MDNPI 1447258850
Title
Owner
Phone
(409) 892-2111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X L6963 TX Primary

Addresses

Primary practice location

3030 North St
#310
Beaumont, TX 77702-1433

Mailing address

PO Box 12499
3030 N St #310
Beaumont, TX 77726-2499
Phone (409) 892-2111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041020000626 TX Part B Supplier - Clinic/Group Practice 5799746079 Receives reassigned benefits from 5 practitioners
Practice locations: Beaumont, TX

National Provider Directory

National Provider Directory

Locations

3440 Fannin St
Beaumont, TX 77701
Phone (409) 833-6900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FDAAAA

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1043218514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12499",
            "address_2": "3030 N ST #310",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777262499",
            "telephone_number": "409-892-2111",
            "fax_number": "409-892-2173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 NORTH ST",
            "address_2": "#310",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021433",
            "telephone_number": "409-892-2111",
            "fax_number": "409-892-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANDASWAMY JAYARAJ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "JAYARAJ",
        "authorized_official_first_name": "KANDASWAMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-892-2111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "L6963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.