NPIMap

Individual provider Active NPI

Krishnasamy Soundararajan, M.D.

  • Vascular Surgery Physician
  • New York, NY
National Provider Identifier
1306947783
Registry record updated Oct 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD061319L Issued in PA
Practice address
1190 5TH Ave
GP1, 1St Floor
New York, NY 10029
Phone
(212) 241-5603
Fax
(212) 987-9310
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD061319L PA Primary

Addresses

Primary practice location

1190 5TH Ave
GP1, 1St Floor
New York, NY 10029

Mailing address

1425 Madison Avenue
Box 1273
New York, NY 10029

Other practice location 1

One Medical Center Blvd
Suite 233
Upland, PA 19013-3902
Phone (610) 499-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150317000100 NY Practitioner - Vascular SurgeryPractitioner - General SurgeryPractitioner - General Practice 6800816091 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

4572 Parsons Blvd
Flushing, NY 11355-2221
Phone (718) 886-4848

Hospital & facility affiliations

  • VNS of Ny Home Care Chha Home health agency, New York, NY, CCN 337008
  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024
  • Queens Hospital Center Hospital, Jamaica, NY, CCN 330231

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD061319LPAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2015 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2015 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2015 Accepting new patients
Metropolitan Medical Practice Plan PC CurrentSince Dec 13, 2017 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2015 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Vascular Surgery Current Accepting new patients
Creighton University Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
Creighton University Past Accepting new patients

Locations

7901 Broadway
#A119
Elmhurst, NY 11373
Phone (718) 334-2488

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-3915

13620 38th Ave
Flushing, NY 11354
Phone (718) 353-7701

4572 Parsons Blvd
Flushing, NY 11355
Phone (718) 886-4848

1901 1st Ave
New York, NY 10029
Phone (212) 230-6262

1190 5th Ave
#1
New York, NY 10029
Phone (212) 241-4971

1425 Madison Ave
#1273
New York, NY 10029
Phone (650) 580-3624

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

1190 5th Ave
Fl 1
New York, NY 10029

Networks

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

Organizations & group practices 11

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 8

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508889600000",
    "number": "1306947783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 MADISON AVENUE",
            "address_2": "BOX 1273",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 5TH AVE",
            "address_2": "GP1, 1ST FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10029",
            "telephone_number": "212-241-5603",
            "fax_number": "212-987-9310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Medical Center Blvd",
            "address_2": "Suite 233",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "PA",
            "postal_code": "190133902",
            "country_code": "US",
            "telephone_number": "610-499-0400",
            "fax_number": "610-499-1970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUNDARARAJAN",
        "first_name": "KRISHNASAMY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD061319L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.