Theodora Kanellopoulos, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

021101 Issued in NY

Practice address

21 Bloomingdale Rd
7 South
White Plains, NY 10605-1504

Phone

(917) 886-4779

NPI assigned

Apr 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as apm

Quality

85.32

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Weill Medical College of Cornell

  • Internal Medicine Physician
  • New York, NY
  • NPI 1124170212
  Medicare reassignment Care Compare group NPD
• New York Gracie Square Hospital Inc

  • Psychiatric Hospital
  • New York, NY
  • NPI 1215911946
  Medicare reassignment NPD
• Weill Medical College of Cornell

  • Cardiovascular Disease Physician
  • New York, NY
  • NPI 1144729385
  NPD
• Weill Medical College of Cornell University

  • Psychologist
  • White Plains, NY
  • NPI 1538352026
  NPD

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430352000000",
    "number": "1083091870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 BLOOMINGDALE RD",
            "address_2": "7 SOUTH",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051504",
            "telephone_number": "917-886-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 BLOOMINGDALE RD",
            "address_2": "7 SOUTH",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051504",
            "telephone_number": "917-886-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANELLOPOULOS",
        "first_name": "THEODORA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "021101",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Antonia Kakavas, FNP BC, MSN
• Mary Kay Kallergis
• Russell Kamer, M.D.
• Rachel Kaminer, P.T.
• Alexander Kane, M.D.
• Jennifer Kang
• Ramanjot S Kang, MD
• Sun-Woong Kang, DO
• Leo J Kannanganamalil, RPH
• Alexandra Hara Kanter

• Clinical Neuropsychologist in White Plains, NY
• Providers in White Plains, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.