NPIMap

Individual provider Active NPI

Madhavi Pentyala, M.D.

  • Internal Medicine Physician
  • Livingston, NJ
National Provider Identifier
1265490072
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07939700 Issued in NJ
Practice address
22 Old Short Hills Rd
Suite 213
Livingston, NJ 07039-5604
Phone
(973) 992-0658
Fax
(973) 992-6655
NPI assigned
May 2, 2006
Last updated
May 20, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07939700 NJ Primary

Addresses

Primary practice location

22 Old Short Hills Rd
Suite 213
Livingston, NJ 07039-5604

Mailing address

1 Schanck Dr
Edison, NJ 08820-2417
Phone (973) 992-0658

Other identifiers 1

IdentifierTypeStateIssuer
0079855MedicaidNJ

Other names 1

  • Madhavi Kakumanu Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20050921000295 NJ Practitioner - Internal Medicine 4082645866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

22 Old Short Hills Rd
Suite 213
Livingston, NJ 07039-5600
Phone (973) 992-0658

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mega Healthcare LLC CurrentSince Sep 7, 2013 Accepting new patients
Ipc Hospitalist Physicians of New Jersey PC Internal Medicine Past Accepting new patients
Cooperman Barnabas Medical Center Inc Past Accepting new patients
Barnabas Health Medical Group, PC Internal Medicine PastSince Jan 15, 2007 Accepting new patients
Ipc Hospitalist Physicians of New Jersey PC Internal Medicine Past Accepting new patients
Hospital Medicine Associates, P.C. Internal Medicine Past Accepting new patients

Locations

22 Old Short Hills Rd
Ste 213
Livingston, NJ 07039
Phone (973) 535-3800

Organizations & group practices 6

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 6

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1265490072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SCHANCK DR",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088202417",
            "telephone_number": "973-992-0658",
            "fax_number": "973-992-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 OLD SHORT HILLS RD",
            "address_2": "SUITE 213",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395604",
            "telephone_number": "973-992-0658",
            "fax_number": "973-992-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTYALA",
        "first_name": "MADHAVI",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07939700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079855",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADHAVI",
            "last_name": "KAKUMANU",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.