NPIMap

Individual provider Active NPI

Khetisuda Suvarnasuddhi, M.D.

  • Nephrology Physician
  • Hagerstown, MD
National Provider Identifier
1083059455
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
D0085666 Issued in MD
Practice address
12931 Oak Hill Ave
Hagerstown, MD 21742
Phone
(301) 797-9600
Fax
(301) 797-3854
NPI assigned
Apr 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X LP03684 RI
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X D0085666 MD Primary

Addresses

Primary practice location

12931 Oak Hill Ave
Hagerstown, MD 21742

Mailing address

593 Eddy Street, Apc 942
Providence, RI 02903-7752
Phone (401) 444-5445

Other identifiers 1

IdentifierTypeStateIssuer
520968642MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, WV, PA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180828001976 MD Practitioner - NephrologyPractitioner - Internal Medicine 7618270265 Reassigns benefits to 1 organization
I20181002002714 WV Practitioner - NephrologyPractitioner - Internal Medicine 7618270265 Reassigns benefits to 1 organization
I20181023002321 PA Practitioner - Internal MedicinePractitioner - Nephrology 7618270265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Otto Roza MD PAGroup PAC ID 4880596675, 10 clinicians

Practice addresses (Care Compare)

103 Marcley Dr
Martinsburg, WV 25401-2977
Phone (304) 263-0911

12931 Oak Hill Ave
Hagerstown, MD 21742-2914
Phone (301) 797-9600

27 Vista Dr
Waynesboro, PA 17268-2541
Phone (301) 797-9600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
55.98 of 100Reported as group
Quality
67.88
Improvement activities
0
Cost
76.85

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP03684RIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Otto Roza M.D., P.a. Nephrology CurrentSince Sep 3, 2018 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients

Locations

140 Thomas Johnson Dr
Ste 202
Frederick, MD 21702
Phone (301) 620-9899

12931 Oak Hill Ave
Hagerstown, MD 21742
Phone (301) 797-2311

27 Vista Dr
Waynesboro, PA 17268
Phone (301) 797-9600

103 Marcley Dr
Martinsburg, WV 25401
Phone (304) 263-0911

Interoperability endpoints

  • Direct secure messaging: ksuvarnasuddhi25657@direct.wvuhsdirect.com
  • Direct secure messaging: ksuvarnasuddhi21275@direct.acumenmd.com

Organizations & group practices 3

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1083059455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY STREET, APC 942",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029037752",
            "telephone_number": "401-444-5445",
            "fax_number": "401-444-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12931 OAK HILL AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "21742",
            "telephone_number": "301-797-9600",
            "fax_number": "301-797-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUVARNASUDDHI",
        "first_name": "KHETISUDA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-30",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "RI",
            "license": "LP03684",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MD",
            "license": "D0085666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520968642",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.