Individual provider Active NPI

Kanoo Priya

  • Nurse Practitioner
  • San Jose, CA
National Provider Identifier
1265151336
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95024773 Issued in CA
Practice address
2425 Samaritan Dr
San Jose, CA 95124-3908
Phone
(408) 559-2011
NPI assigned
Aug 23, 2022
Last updated
Oct 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95024773 CA Primary

Addresses

Primary practice location

2425 Samaritan Dr
San Jose, CA 95124-3908

Mailing address

PO Box 743111
Atlanta, GA 30374-3111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230127001433 NY Practitioner - Nurse Practitioner 0941671002 Reassigns benefits to 1 organization
I20230920001540 CA Practitioner - Nurse Practitioner 0941671002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Golden State Providers, a Medical CorporationGroup PAC ID 7012212475, 23 clinicians

Practice addresses (Care Compare)

2425 Samaritan Dr
San Jose, CA 95124-3908
Phone (408) 559-2588

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
350171NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Oct 24, 2022 Accepting new patients
Golden State Providers, a Medical Corporation CurrentSince Oct 23, 2023 Accepting new patients
County of Santa Clara Past Accepting new patients

Locations

4510 Brockton Ave
Ste 175
Riverside, CA 92501
Phone (951) 786-5100

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

330 Community Dr
Manhasset, NY 11030
Phone (516) 562-8000

972 Brush Hollow Rd
Westbury, NY 11590

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: kanoo.priya@hca3.eclinicaldirectplus.com
  • Direct secure messaging: kanoopriya@nslijmedgr.allscriptsdirect.net

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": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1265151336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743111",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 SAMARITAN DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951243908",
            "telephone_number": "408-559-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIYA",
        "first_name": "KANOO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95024773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.