Individual provider Active NPI

Kavitha M Prezzano, MD

  • Radiation Oncology Physician
  • East Syracuse, NY
National Provider Identifier
1265819312
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
302766 Issued in NY
Practice address
5008 Brittonfield Pkwy Ste 700
East Syracuse, NY 13057-9249
Phone
(315) 472-7504
Fax
(315) 634-4677
NPI assigned
Apr 28, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 302766 NY Primary

Addresses

Primary practice location

5008 Brittonfield Pkwy Ste 700
East Syracuse, NY 13057-9249

Mailing address

5008 Brittonfield Pkwy Ste 700
East Syracuse, NY 13057-9249
Phone (315) 472-7504

Other identifiers 1

IdentifierTypeStateIssuer
302766OtherNYNYS LICENSE

Other names 1

  • Kavitha Mannava Former name

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
I20200714001901 NY Practitioner - Radiation Oncology 2163767690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hematology-Oncology Associates of Cny, PCGroup PAC ID 6709787823, 65 clinicians

Practice addresses (Care Compare)

5008 Brittonfield Pkwy
East Syracuse, NY 13057-9248
Phone (315) 472-7504

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
302766NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hematology-Oncology Associates of Cny, PC Radiation Oncology CurrentSince Aug 1, 2020 Accepting new patients

Locations

5008 Brittonfield Pkwy
Ste 700
East Syracuse, NY 13057

5008 Brittonfield Pkwy
East Syracuse, NY 13057
Phone (315) 634-5056

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1265819312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 BRITTONFIELD PKWY STE 700",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579249",
            "telephone_number": "315-472-7504",
            "fax_number": "315-634-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5008 BRITTONFIELD PKWY STE 700",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579249",
            "telephone_number": "315-472-7504",
            "fax_number": "315-634-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREZZANO",
        "first_name": "KAVITHA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-28",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NY",
            "license": "302766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "302766",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAVITHA",
            "last_name": "MANNAVA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.