Individual provider Active NPI

Roopa Avula, MD

  • Emergency Medicine Physician
  • Staten Island, NY
National Provider Identifier
1225535727
Registry record updated Sep 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
316322 Issued in NY
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(718) 818-2345
NPI assigned
Apr 11, 2018
Last updated
Sep 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2022

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 NU
Emergency Medicine Physician 207P00000X 316322 NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

110 Mundy Ave
Staten Island, NY 10310-2630
Phone (917) 566-2680

Other practice location 1

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (551) 996-2000

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
I20221129000448 NY Practitioner - Emergency Medicine 5890163646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fpa Hospital BasedGroup PAC ID 4789826694, 423 clinicians

Practice addresses (Care Compare)

355 Bard Ave
Staten Island, NY 10310-1664
Phone (718) 818-1015

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
316322NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based Emergency Medicine CurrentSince Dec 1, 2022 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Fpa Hospital Based CurrentSince Dec 1, 2022 Accepting new patients

Locations

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

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 1

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662336000000",
    "number": "1225535727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MUNDY AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102630",
            "telephone_number": "917-566-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076011915",
            "country_code": "US",
            "telephone_number": "551-996-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVULA",
        "first_name": "ROOPA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2022-09-05",
        "certification_date": "2022-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "316322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.