Individual provider Active NPI

Muthaiah Chandrasekhara, MD

  • Psychiatry Physician
  • Middletown, NY
National Provider Identifier
1225178569
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
143024-1 Issued in NY
Practice address
15 Fortune Rd W
Middletown, NY 10941-1625
Phone
(845) 692-4454
NPI assigned
Feb 7, 2007
Last updated
Aug 13, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 143024-1 NY Primary

Addresses

Primary practice location

15 Fortune Rd W
Middletown, NY 10941-1625

Mailing address

15 Fortune Rd W
Middletown, NY 10941-1625
Phone (845) 692-4454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20071008000263 NY Practitioner - Psychiatry 7618062597 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
143024-1NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Access: Supports for Living Inc CurrentSince Jun 30, 2022 Accepting new patients
Access: Supports for Living Inc. CurrentSince Jun 30, 2022 Accepting new patients

Locations

16 Union St
Middletown, NY 10940
Phone (845) 343-5556

67 Windsor Hwy
Newburgh, NY 12553
Phone (845) 562-6850

15 Fortune Rd W
Scotchtown, NY 10941
Phone (845) 673-7123

Organizations & group practices 2

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": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186963200000",
    "number": "1225178569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD W",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411625",
            "telephone_number": "845-692-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD W",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411625",
            "telephone_number": "845-692-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDRASEKHARA",
        "first_name": "MUTHAIAH",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "143024-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.