NPIMap

Individual provider Active NPI

Ayesha Venkateswaran

  • Hospitalist Physician
  • Kotzebue, AK
National Provider Identifier
1285047142
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2021048199 Issued in MO
Practice address
436 5TH Avenue
Kotzebue, AK 99752-0043
Phone
(907) 442-3321
NPI assigned
Jun 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60746395 WA
Family Medicine Physician 207Q00000X 69730 AZ
Hospitalist Physician 208M00000X 2021048199 MO Primary

Addresses

Primary practice location

436 5TH Avenue
Kotzebue, AK 99752-0043

Mailing address

PO Box 43
Kotzebue, AK 99752-0043
Phone (907) 442-3321

Other practice location 1

Navajo Route 4
Pinon, AZ 86510
Phone (928) 725-9500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20200303002357 TX Practitioner - Family Practice 1052615903 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS PHS Naihs Chinle Comprehensive Health Care FacilityGroup PAC ID 9436062585, 160 clinicians
DHHS,PHS,Naihs, Gallup Indian Medical CenterGroup PAC ID 3173436409, 179 clinicians

Practice addresses (Care Compare)

2175 State Rd
Suite 4
Pinon, AZ 86510-2147
Phone (928) 725-9000

516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000

Hospital & facility affiliations

  • Gallup Indian Medical Center Hospital, Gallup, NM, CCN 320061
  • Chinle Comprehensive Health Care Facility Hospital, Chinle, AZ, CCN 030084

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

Merit-based Incentive Payment System (MIPS)

Final score
80.86 of 100Reported as group
Quality
61.32
Improvement activities
40
Cost
90.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69730AZMDFamily Medicine Physician
MD60746395WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Sep 8, 2025 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Feb 6, 2023 Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Feb 3, 2020 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Sep 12, 2022 Accepting new patients
Maniilaq Association CurrentSince May 1, 2023 Accepting new patients
Maniilaq Association CurrentSince May 1, 2023 Accepting new patients
DHHS IHS Phoenix Area Family Medicine CurrentSince Nov 11, 2020 Accepting new patients
Maniilaq Association Current Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Feb 6, 2023 Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Feb 3, 2020 Accepting new patients

Locations

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Interoperability endpoints

  • Direct secure messaging: avenkateswaran807560@wm.providencedirect.org

Organizations & group practices 12

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": "1402272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1285047142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-442-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 5TH AVENUE",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520043",
            "telephone_number": "907-442-3321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Navajo Route 4",
            "address_purpose": "LOCATION",
            "city": "Pinon",
            "state": "AZ",
            "postal_code": "86510",
            "country_code": "US",
            "telephone_number": "928-725-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VENKATESWARAN",
        "first_name": "AYESHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-09",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60746395",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "69730",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2021048199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kotzebue, AK

Sources for this page

Verify at the official NPI Registry.