Individual provider Active NPI

Annamma John, M.D.

  • Internal Medicine Physician
  • White Plains, NY
National Provider Identifier
1144220989
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
214579 Issued in NY
Practice address
3 Barker Ave
FL 4
White Plains, NY 10601-1509
Phone
(914) 949-1199
Fax
(914) 949-1245
NPI assigned
Jul 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 214579 NY Primary

Addresses

Primary practice location

3 Barker Ave
FL 4
White Plains, NY 10601-1509

Mailing address

3 Barker Ave
FL 4
White Plains, NY 10601-1509
Phone (914) 949-1199

Other identifiers 1

IdentifierTypeStateIssuer
01951257MedicaidNY

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
I20091208000546 NY Practitioner - Internal Medicine 9638218415 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
214579NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NV Pacs 2 LLC CurrentSince Jul 1, 2021 Accepting new patients
CS Pacs 3 Northeast, LLC CurrentSince Jan 28, 2024 Accepting new patients
New York General Medical Services PC CurrentSince Dec 1, 2017 Accepting new patients
Northwell Health Stern Family Center for Rehabilitation Past Accepting new patients

Locations

3530 Wayne Ave
Bronx, NY 10467
Phone (718) 655-1700

6411 Beach Channel Dr
Far Rockaway, NY 11692
Phone (718) 471-7010

4241 201st St
Flushing, NY 11361
Phone (516) 599-5688

2090 Albany Post Rd
Montrose, NY 10548
Phone (914) 788-6003

21 Ferncliff Dr
Rhinebeck, NY 12572
Phone (845) 516-1663

17850 Linden Blvd
Rochdale Village, NY 11434
Phone (718) 990-0300

1 Elsie St
Rome, NY 13440
Phone (315) 336-4435

101 Elm St
Sayville, NY 11782
Phone (631) 244-2400

100 Lake Rd
Vly Cottage, NY 10989
Phone (845) 268-6813

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1144220989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BARKER AVE",
            "address_2": "FL 4",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106011509",
            "telephone_number": "914-949-1199",
            "fax_number": "914-949-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BARKER AVE",
            "address_2": "FL 4",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106011509",
            "telephone_number": "914-949-1199",
            "fax_number": "914-949-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "ANNAMMA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-22",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "214579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01951257",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.