Individual provider Active NPI

Krishna P Mukkamala, MD

  • Anesthesiology Physician
  • Buffalo, NY
National Provider Identifier
1063445658
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
237577 Issued in NY
Practice address
100 High St
Buffalo, NY 14203-1126
Phone
(716) 859-2220
Fax
(716) 859-1521
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 237577 NY Primary

Addresses

Primary practice location

100 High St
Buffalo, NY 14203-1126

Mailing address

406 Linwood Ave Rear
Buffalo, NY 14209-1629
Phone (716) 886-0444

Other identifiers 1

IdentifierTypeStateIssuer
02685692MedicaidNY

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20051025000567 NY Practitioner - Anesthesiology 0446277826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maple Gate Anesthesiologists, P.C.Group PAC ID 8022913839, 113 clinicians

Practice addresses (Care Compare)

818 Ellicott St
Buffalo, NY 14203-1021
Phone (716) 632-1088

Hospital & facility affiliations

  • Kaleida Health Hospital, Buffalo, NY, CCN 330005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
237577NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maple Gate Anesthesiologists, P.C. Anesthesiology CurrentSince Jan 1, 2010 Accepting new patients
Parkside Medical Anesthesia Associates Anesthesiology CurrentSince Jul 18, 2023 Accepting new patients

Locations

818 Ellicott St
Buffalo, NY 14203
Phone (716) 323-2000

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

875 Ellicott St
Buffalo, NY 14203
Phone (716) 748-2000

3871 Harlem Rd
Ste 202
Buffalo, NY 14215

2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501

2568 Walden Ave
Ste 103
Cheektowaga, NY 14225

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

215 Klein Rd
Williamsville, NY 14221
Phone (716) 568-6100

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

Organizations & group practices 2

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 6

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063445658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 LINWOOD AVE REAR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142091629",
            "telephone_number": "716-886-0444",
            "fax_number": "716-885-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGH ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031126",
            "telephone_number": "716-859-2220",
            "fax_number": "716-859-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKAMALA",
        "first_name": "KRISHNA",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "237577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02685692",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.