Individual provider Active NPI

Amy Kakkanatt, M.D.

  • Pediatric Endocrinology Physician
  • Indianapolis, IN
National Provider Identifier
1164734570
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
0101264932 Issued in VA
Practice address
8402 Harcourt Rd Ste 300
Indianapolis, IN 46260-2052
Phone
(317) 338-3100
NPI assigned
Jul 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301097290 MI
Pediatric Endocrinology Physician 2080P0205X 0101264932 VA Primary

Addresses

Primary practice location

8402 Harcourt Rd Ste 300
Indianapolis, IN 46260-2052

Mailing address

8402 Harcourt Rd Ste 300
Indianapolis, IN 46260-2052

Other practice location 1

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone (248) 551-6489

Other practice location 2

1204 W Main St
Charlottesville, VA 22903-2824
Phone (434) 924-0123

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akakkanatt417386@direct.healthsystem.virginia.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20240403003229 SC Practitioner - Pediatric MedicinePractitioner - Endocrinology 4981837028 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301097290MIMDInternal Medicine Physician
91324SCMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
University Medical Associates of the Medical University of South Carol Internal Medicine CurrentSince Jan 22, 2024 Accepting new patients
University Medical Associates of the Medical University of South Carol Internal Medicine CurrentSince Jan 22, 2024 Accepting new patients
Major Hospital Past Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

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": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1164734570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602052",
            "telephone_number": "317-338-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 W 13 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736712",
            "country_code": "US",
            "telephone_number": "248-551-6489",
            "fax_number": "248-551-8880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1204 W Main St",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229032824",
            "country_code": "US",
            "telephone_number": "434-924-0123",
            "fax_number": "434-243-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAKKANATT",
        "first_name": "AMY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-14",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301097290",
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "VA",
            "license": "0101264932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akakkanatt417386@direct.healthsystem.virginia.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1204 W Main St",
            "city": "Charlottesville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229032824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.