Individual provider Active NPI

Akila Venkataraman, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Wilkes Barre, PA
National Provider Identifier
1164417879
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
MD471964 Issued in PA
Practice address
1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027
Phone
(570) 808-7300
NPI assigned
Sep 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X 001613 NY
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MD471964 PA Primary

Addresses

Primary practice location

1000 E Mountain Blvd
Wilkes Barre, PA 18711-0027

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 12

IdentifierTypeStateIssuer
02350567MedicaidNY
2603656OtherNYGHI
0100559OtherNYAMERICHOICE
2196604 04OtherNYUNITED HEALTHCARE
7863378OtherNYAETNA PPO
P2640917OtherNYOXFORD HEALTH PLAN
127400101OtherNYHEALTH PLUS
001613-A15OtherNYHEALTH FIRST
501Z91OtherNYEMPIRE BCBS
1000028191OtherNYAFFINITY HEALTH
2969639OtherNYAETNA USHC HMO
4C2294OtherNYHEALTH NET

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address avenkataraman312129@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100616000228 NY Practitioner - NeurologyPractitioner - Pediatric Medicine 9739219882 Reassigns benefits to 3 organizations
I20201111000456 PA Practitioner - Neurology 9739219882 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD471964PAMDNeurology with Special Qualifications in Child Neurology Physician
001613NYMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince May 1, 2019 Accepting new patients
Physicians of University Hospital, PC CurrentSince Sep 15, 2016 Accepting new patients
New York University CurrentSince Jan 15, 2015 Accepting new patients
Evangelical Medical Services Organization CurrentSince Aug 18, 2021 Accepting new patients
New York University CurrentSince Jan 15, 2015 Accepting new patients
Geisinger Clinic Current Accepting new patients
Evangelical Medical Services Organization Current Accepting new patients
Geisinger Clinic CurrentSince Aug 9, 2020 Accepting new patients
Physicians of University Hospital, PC CurrentSince Sep 15, 2016 Accepting new patients
Evangelical Medical Services Organization CurrentSince Aug 18, 2021 Accepting new patients
NYU Lutheran Medical Center Past Accepting new patients
MMC Pediatrics Faculty Practice Past Accepting new patients
Geisinger Clinic Past Accepting new patients
Geisinger Wyoming Valley Medical Center Past Accepting new patients

Locations

150 55th St
Rm 3618
Brooklyn, NY 11220
Phone (718) 630-7477

8714 5th Ave
Brooklyn, NY 11209
Phone (718) 630-8600

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

403 E 34th St
Fl 4
New York, NY 10016
Phone (212) 263-8870

223 E 34th St
New York, NY 10016
Phone (212) 263-8854

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

300 Community Dr
Plandome, NY 11030

1 Edgewater St
Fl 6
Staten Island, NY 10305
Phone (718) 226-1047

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

501 Seaview Ave
Staten Island, NY 10305
Phone (718) 667-4700

401 Seaview Ave
Lowr
Staten Island, NY 10305
Phone (718) 226-6186

972 Brush Hollow Rd
Westbury, NY 11590

100 N Academy Ave
Danville, PA 17822

25 Lystra Rogers Dr
Lewisburg, PA 17837
Phone (570) 523-3290

3 Hospital Dr
Ste 206
Lewisburg, PA 17837
Phone (570) 522-9771

1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

Interoperability endpoints

  • Direct secure messaging: avenkataraman489664@wellspan.direct-ci.com

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1164417879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATARAMAN",
        "first_name": "AKILA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "NY",
            "license": "001613",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "PA",
            "license": "MD471964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02350567",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2603656",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "0100559",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2196604 04",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7863378",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLAN",
            "identifier": "P2640917",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "127400101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST",
            "identifier": "001613-A15",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "501Z91",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AFFINITY HEALTH",
            "identifier": "1000028191",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC HMO",
            "identifier": "2969639",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "4C2294",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "avenkataraman312129@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1000 E Mountain Blvd",
            "city": "Wilkes Barre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187110027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.