Yulianty D. Kusuma, MD

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

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Yulianty D. Heanacho Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

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)

Hospital & facility affiliations

• St Joseph'S/Candler Home Healthcare, Inc Home health agency, Savannah, GA, CCN 117143
• Amedisys Home Health Home health agency, Savannah, GA, CCN 117078
• Pruitthealth Hospice-Swainsboro Hospice, Swainsboro, GA, CCN 111572
• Candler Hospital Hospital, Savannah, GA, CCN 110024
• Savannah Health Services LLC Dba Memorial Health University Medical Center Hospital, Savannah, GA, CCN 110036
• St Joseph'S Hospital - Savannah Hospital, Savannah, GA, CCN 110043

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Internal Medicine of Savannah, LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1346514114
  Medicare reassignment Care Compare group NPD
• Margaret Ellis, MD, LLC

  • Developmental - Behavioral Pediatrics Physician
  • Savannah, GA
  • NPI 1275022907
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Georgia, L.L.C.

  • Home Health Agency
  • Savannah, GA
  • NPI 1942483920
  Care Compare affiliation
• Candler Hospital Incorporated

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1275527889
  Care Compare affiliation
• Pruitthealth Hospice, Inc

  • Community Based Hospice Care Agency
  • Swainsboro, GA
  • NPI 1013955749
  Care Compare affiliation
• Pruitthealth Hospice, Inc.

  • Community Based Hospice Care Agency
  • Savannah, GA
  • NPI 1922238872
  Care Compare affiliation
• Saint Joseph'S Hospital, Inc.

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1063406684
  Care Compare affiliation
• Savannah Health Services, LLC

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1053824292
  Care Compare affiliation
• SJC Home Health Services Inc

  • Home Health Agency
  • Savannah, GA
  • NPI 1821082371
  Care Compare affiliation

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007011626A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52233988",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01279332",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "469648",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01048571",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00649653",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G61279",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YULIANTY",
            "last_name": "HEANACHO",
            "middle_name": "D.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victoria Kuhn, FNP-C
• Melissa S Kuljanin, PHARMD
• Anand Raj Kumar, M.D.
• Dana A Kumjian, MD
• Pathya Kunthy, DO, MPH
• KWK Freight Enterprise
• Jiye Kwon Kim
• Cholponai Kydyralieva
• Peri Kyriacos, LCSW
• L. Rochelle Ainsworth, LLC

• Internal Medicine Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.