Individual provider Active NPI

Anna Varghese, MD

  • Internal Medicine Physician
  • Pomona, NY
National Provider Identifier
1194986372
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0051386 Issued in CO
Practice address
54 Tamarack LN
Pomona, NY 10970-2012
Phone
(848) 641-8629
NPI assigned
Jun 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X DR.0051386 CO Primary

Addresses

Primary practice location

54 Tamarack LN
Pomona, NY 10970-2012

Mailing address

54 Tamarack LN
Pomona, NY 10970-2012
Phone (848) 641-8629

Other identifiers 1

IdentifierTypeStateIssuer
51857553MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20111212000049 TX Practitioner - Internal Medicine 1456526094 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0051386COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium CurrentSince Jul 2, 2013 Accepting new patients
DHHS, PHS, Naihs, Gallup Indian Medical Center CurrentSince Oct 25, 2011 Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Oct 25, 2011 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1194986372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 TAMARACK LN",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109702012",
            "telephone_number": "848-641-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 TAMARACK LN",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109702012",
            "telephone_number": "848-641-8629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "ANNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0051386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51857553",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, NY

Sources for this page

Verify at the official NPI Registry.