Individual provider Active NPI

Suma Chandra Kannabiran, MD

  • Diagnostic Radiology Physician
  • Worcester, MA
National Provider Identifier
1053602235
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
279413 Issued in MA
Practice address
55 Lake Avenue North
Department of Radiology
Worcester, MA 01655
Phone
(508) 334-1000
NPI assigned
Apr 22, 2011
Last updated
May 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 279413 MA Primary

Addresses

Primary practice location

55 Lake Avenue North
Department of Radiology
Worcester, MA 01655

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other identifiers 1

IdentifierTypeStateIssuer
110134748AMedicaidMA

Other names 1

  • Dr. Suma Kanakalalita Chandra Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address skannabiran241217@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 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
I20191016000142 MA Practitioner - Diagnostic Radiology 5294086948 Reassigns benefits to 2 organizations
I20250417003000 NH Practitioner - Diagnostic Radiology 5294086948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Georgetown University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Hutchinson Dr
Danvers, MA 01923-3748
Phone (978) 354-4181

102 Endicott St
Danvers, MA 01923-3623
Phone (978) 354-4181

15 Corporate Park Dr
Pembroke, MA 02359-1966
Phone (781) 826-8065

170 Governors Ave
Medford, MA 02155-1643
Phone (781) 395-4909

2014 Washington St
Newton, MA 02462-1607
Phone (617) 243-6000

480 Lynnfield St
Lynn, MA 01904-1419
Phone (781) 342-4386

81 Highland Ave
Salem, MA 01970-2714
Phone (978) 354-4181

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
279413MAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Massachusetts Regional MRI, Limited Partnership CurrentSince Dec 1, 2019 Accepting new patients
Shields Healthcare of Cambridge, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Mass General Brigham Medical Group Suburban Massachusetts Inc CurrentSince Aug 1, 2021 Accepting new patients
Mass General Brigham Community Physicians Inc CurrentSince May 22, 2025 Accepting new patients
Newton Wellesley Hospital Current Accepting new patients

Locations

170 Governors Ave
Medford, MA 02155
Phone (781) 306-6000

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

399 Revolution Dr
Ste 1010
Somerville, MA 02145
Phone (857) 282-0165

30 Tuscan Blvd
Salem, NH 03079
Phone (857) 282-8100

Interoperability endpoints

  • Direct secure messaging: kannabiran.suma.nwh@direct.partners.masshiway.net
  • Direct secure messaging: skannabiran241217@umassmemorial.direct-ci.com

Organizations & group practices 5

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

Hospital & facility affiliations 4

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": "1303430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1053602235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVENUE NORTH",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01655",
            "telephone_number": "508-334-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNABIRAN",
        "first_name": "SUMA",
        "middle_name": "CHANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-22",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "279413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110134748A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skannabiran241217@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Avenue North",
            "address_2": "Department of Radiology",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "01655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Avenue North",
            "address_2": "Department of Radiology",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "01655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUMA",
            "last_name": "CHANDRA",
            "middle_name": "KANAKALALITA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.