NPIMap

Individual provider Active NPI

Yulianty D. Kusuma, MD

  • Internal Medicine Physician
  • Savannah, GA
National Provider Identifier
1265627145
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
061279 Issued in GA
Practice address
6413 Waters Ave
Suite 102
Savannah, GA 31406-2711
Phone
(912) 349-6624
Fax
(912) 354-4694
NPI assigned
Sep 13, 2007
Last updated
Aug 25, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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 061279 GA Primary

Addresses

Primary practice location

6413 Waters Ave
Suite 102
Savannah, GA 31406-2711

Mailing address

6413 Waters Ave
Suite 102
Savannah, GA 31406-2711
Phone (912) 349-6624

Other names 1

  • Yulianty D. Heanacho Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20080723000682 GA Practitioner - Internal Medicine 8426121450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Rehab Services, LLCGroup PAC ID 5597752063, shared by 3 NPIs, 143 clinicians
Internal Medicine of Savannah, LLCGroup PAC ID 2466614425, 4 clinicians

Practice addresses (Care Compare)

123 Canal St
Suite 203
Pooler, GA 31322-4104
Phone (912) 988-1283

6413 Waters Ave
Suite 102
Savannah, GA 31406-2711
Phone (912) 349-6624

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
061279GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine of Savannah, LLC Internal Medicine CurrentSince Apr 1, 2012 Accepting new patients
Margaret Ellis, MD, LLC PastSince Apr 1, 2012 Accepting new patients

Locations

114 Canal St
Ste 102
Pooler, GA 31322
Phone (912) 349-6624

6413 Waters Ave
#102
Savannah, GA 31406
Phone (912) 349-6624

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.

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": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1265627145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6413 WATERS AVE",
            "address_2": "SUITE 102",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062711",
            "telephone_number": "912-349-6624",
            "fax_number": "912-354-4694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6413 WATERS AVE",
            "address_2": "SUITE 102",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062711",
            "telephone_number": "912-349-6624",
            "fax_number": "912-354-4694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSUMA",
        "first_name": "YULIANTY",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "061279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YULIANTY",
            "last_name": "HEANACHO",
            "middle_name": "D.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.