NPIMap

Individual provider Active NPI

Vidhyalakshmi Kannan, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Mesa, AZ
National Provider Identifier
1275724452
Registry record updated Feb 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
46525 Issued in AZ
Practice address
10238 E Hampton Ave
Mesa, AZ 85209-3316
Phone
(480) 257-2669
NPI assigned
Aug 5, 2007
Last updated
Feb 6, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BP1-0029419 TX
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 46525 AZ Primary

Addresses

Primary practice location

10238 E Hampton Ave
Mesa, AZ 85209-3316

Mailing address

10238 E Hampton Ave
Mesa, AZ 85209-3316
Phone (480) 257-2669

Other identifiers 2

IdentifierTypeStateIssuer
4663378067OtherMYUTMB 4663378067
46525OtherAZAZ STATE MEDICAL LICENSE BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20121029000570 AZ Practitioner - Endocrinology 7012167000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8427 E Baseline Rd
BLDG E1 Suite 104
Mesa, AZ 85209-4039
Phone (480) 832-0900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.78 of 100Reported as individual
Quality
92.93
Promoting interoperability
91
Improvement activities
40
Cost
72.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP1-0029419TXMDInternal Medicine Physician
46525AZMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Sky Endocrinology Associates PLC Endocrinology, Diabetes & Metabolism CurrentSince Aug 3, 2016 Accepting new patients
Physician Group of Arizona Inc Past Accepting new patients

Locations

7115 E Baseline Rd
Ste 110
Mesa, AZ 85209
Phone (480) 626-4999

8427 E Baseline Rd
Ste 104
Mesa, AZ 85209
Phone (480) 832-0900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIAGAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/GIAGAD/Endpoint/GIAGAD

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 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": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423180800000",
    "number": "1275724452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10238 E HAMPTON AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093316",
            "telephone_number": "480-257-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10238 E HAMPTON AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093316",
            "telephone_number": "480-257-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNAN",
        "first_name": "VIDHYALAKSHMI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2015-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP1-0029419",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "AZ",
            "license": "46525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 4663378067",
            "identifier": "4663378067",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ STATE MEDICAL LICENSE BOARD",
            "identifier": "46525",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.