Individual provider Active NPI

Karthyayani Kunchappa, PT

  • Physical Therapist
  • Jackson, MI
National Provider Identifier
1184641847
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
2973 Springport Rd
Jackson, MI 49201-9060
Phone
(517) 435-3461
Fax
(517) 768-9951
NPI assigned
Jul 17, 2006
Last updated
Nov 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X KK007396 MI
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

2973 Springport Rd
Jackson, MI 49201-9060

Mailing address

625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 575-1916

Other identifiers 1

IdentifierTypeStateIssuer
650C807050OtherMIBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
KK007396MIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
M.P.K. Medical Equipments LTD Current Accepting new patients
Victory Physical Therapy, PC Physical Therapist Current Accepting new patients
Preferred Rehab Care Inc Physical Therapist PastSince May 1, 2003 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: karthyayani.kunchappa.p4@direct.athleticoltd.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478217600000",
    "number": "1184641847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-1916",
            "fax_number": "630-928-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2973 SPRINGPORT RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492019060",
            "telephone_number": "517-435-3461",
            "fax_number": "517-768-9951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNCHAPPA",
        "first_name": "KARTHYAYANI",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2016-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "KK007396",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "650C807050",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.