NPIMap

Individual provider Active NPI

Sreedhar P. Sudnagunta, R.P.A.-C

  • Physician Assistant
  • Mineola, NY
National Provider Identifier
1215191580
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006568 Issued in NY
Practice address
80 E Jericho Tpke
Suite 100
Mineola, NY 11501-3140
Phone
(516) 877-2626
Fax
(516) 877-0945
NPI assigned
Jul 15, 2008
Last updated
Sep 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 006568 NY Primary

Addresses

Primary practice location

80 E Jericho Tpke
Suite 100
Mineola, NY 11501-3140

Mailing address

80 E Jericho Tpke
Suite 100
Mineola, NY 11501-3140
Phone (516) 877-2626

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssudnagunta307465@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040909000084 NY Practitioner - Physician Assistant 7719953900 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006568NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Feb 25, 2022 Accepting new patients
New York University CurrentSince Feb 25, 2022 Accepting new patients
Island Wide Medical Associates, PC PastSince Oct 1, 2012 Accepting new patients

Locations

875 Old Country Rd
Ste 102
Plainview, NY 11803
Phone (516) 605-2900

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ssudnagunta307465@nyumc.direct-ci.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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1215191580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 E JERICHO TPKE",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013140",
            "telephone_number": "516-877-2626",
            "fax_number": "516-877-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 E JERICHO TPKE",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013140",
            "telephone_number": "516-877-2626",
            "fax_number": "516-877-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDNAGUNTA",
        "first_name": "SREEDHAR",
        "middle_name": "P.",
        "name_prefix": "Mr.",
        "credential": "R.P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-15",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssudnagunta307465@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "80 E Jericho Tpke",
            "address_2": "Suite 100",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115013140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.