Individual provider Active NPI

Kylash Konanur, D.O.

  • Anesthesiology Physician
  • South Miami, FL
National Provider Identifier
1093120974
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036-148742 Issued in IL
Practice address
7031 SW 62ND Ave
South Miami, FL 33143
Phone
(305) 284-7761
NPI assigned
Jun 30, 2014
Last updated
Apr 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Anesthesiology Physician 207L00000X 34.013155 OH
Anesthesiology Physician 207L00000X 036-148742 IL Primary

Addresses

Primary practice location

7031 SW 62ND Ave
South Miami, FL 33143

Mailing address

700 Ackerman Rd Ste 570
Columbus, OH 43202-1579
Phone (614) 293-8487

Other practice location 1

410 W 10th Ave
Columbus, OH 43210-1240
Phone (614) 293-8487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20200917000077 IL Practitioner - Anesthesiology 7911253752 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allied Anesthesia Associates P CGroup PAC ID 0042118069, 53 clinicians

Practice addresses (Care Compare)

10719 160TH St
Orland Park, IL 60467-5541
Phone (708) 226-3300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-148742ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Lenox Anesthesia LLC Anesthesiology CurrentSince May 6, 2020 Accepting new patients
Allied Anesthesia Associates, P.C. Anesthesiology CurrentSince May 6, 2020 Accepting new patients
Northstar Anesthesia of Illinois, LLC Anesthesiology CurrentSince Jul 30, 2021 Accepting new patients

Locations

403 S Kennedy Dr
Bradley, IL 60915
Phone (815) 928-9999

678 Cedar Crossings Dr
New Lenox, IL 60451
Phone (708) 499-5678

10719 160th St
Orland Park, IL 60467
Phone (702) 263-3300

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1093120974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 570",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021579",
            "telephone_number": "614-293-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7031 SW 62ND AVE",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "33143",
            "telephone_number": "305-284-7761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 W 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101240",
            "country_code": "US",
            "telephone_number": "614-293-8487",
            "fax_number": "614-293-8153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONANUR",
        "first_name": "KYLASH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "34.013155",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036-148742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Miami, FL

Sources for this page

Verify at the official NPI Registry.