NPIMap

Sreedhar Kallakuri

Individual provider Active NPI Vascular Surgery Physician · Brooklyn, NY

NPI 1285645028 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1285645028
Entity type
Individual (NPI type 1)
Primary specialty
Vascular Surgery Physician 2086S0129X
License
217542-1 (NY)
Practice address
2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone
(718) 616-4408
Fax
(718) 616-4105
NPI assigned
Aug 10, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 24

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.

Hospital & facility affiliations 1

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

Medicare Care Compare profile

Specialty
Vascular Surgery
Also: General Surgery
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York City Health and Hospitals Corporation (543 clinicians)

Practice addresses (Care Compare)

2601 Ocean Pkwy
RM 3N17
Brooklyn, NY 11235-7745
Phone (718) 616-3000

594 Albany Ave
Brooklyn, NY 11203-1706
Phone (646) 694-6680

Hospital & facility affiliations

  • South Brooklyn Health Hospital · Brooklyn, NY · CCN 330196

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20040428000689 NY Practitioner - Vascular Surgery
Practitioner - General Surgery		 3072500313 Reassigns benefits to 3 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
217546NYMDLicensed Practical Nurse
217542-1NYMDVascular Surgery Physician

Practice roles (6 of 10)

OrganizationSpecialtyStatusNew patients
University Physicians of Brooklyn, Inc. Current
since Jan 12, 2021		 Accepting new patients
University Physicians of Brooklyn, Inc. Vascular Surgery Current
since Jan 12, 2021		 Accepting new patients
Physician Affiliate Group of New York PC Current
since Mar 1, 2024		 Accepting new patients
University Group Medical Associates, P.C Past Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
MMC University Vascular Surgeons Vascular Surgery Past Accepting new patients

Locations

450 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 270-1603

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

450 Clarkson Ave
#80
Brooklyn, NY 11203
Phone (718) 613-8481

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: skallakuri145855@nychhc.direct-ci.com
  • Direct secure messaging: sreedharkallakuri@sunydmc.allscriptsdirect.net

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 217542-1 NY Yes

Addresses

Primary practice location

2601 Ocean Pkwy
Brooklyn, NY 11235-7745

Mailing address

7 Telegraph Hill Rd
Holmdel, NJ 07733-1465
Phone (732) 739-6764

Other identifiers

IdentifierTypeStateIssuer
02111008MedicaidNY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285645028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 TELEGRAPH HILL RD",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331465",
            "telephone_number": "732-739-6764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357745",
            "telephone_number": "718-616-4408",
            "fax_number": "718-616-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAKURI",
        "first_name": "SREEDHAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "217542-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02111008",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

All providers in Brooklyn, NY · Vascular Surgery Physician in New York

Sources for this page

Verify at the official NPI Registry.