Individual provider Active NPI

Vincent A Mukkada, MD

  • Pediatric Gastroenterology Physician
  • Cincinnati, OH
National Provider Identifier
1316023021
Registry record updated Feb 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
35.120432 Issued in OH
Practice address
3333 Burnet Ave
ML 2010
Cincinnati, OH 45229-3026
Phone
(513) 636-4415
Fax
(513) 636-7805
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 35.120432 OH Primary

Addresses

Primary practice location

3333 Burnet Ave
ML 2010
Cincinnati, OH 45229-3026

Mailing address

3333 Burnet Ave
ML 2010
Cincinnati, OH 45229-3026
Phone (513) 636-4415

Other identifiers 1

IdentifierTypeStateIssuer
MD13019OtherRILICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20130307000178 OH Practitioner - Gastroenterology 8022117845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Cincinnati College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (513) 636-4200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.120432OHMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Medical Center CurrentSince Feb 11, 2013 Accepting new patients
Children'S Hospital Medical Center Past Accepting new patients

Locations

3341 Solutions Ctr
Chicago, IL 60677

3333 Burnet Ave
#2010
Cincinnati, OH 45229
Phone (513) 636-4200

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225

7777 Yankee Rd
#16062
Liberty Township, OH 45044
Phone (513) 636-3200

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359676800000",
    "number": "1316023021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "address_2": "ML 2010",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-4415",
            "fax_number": "513-636-7805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "address_2": "ML 2010",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-4415",
            "fax_number": "513-636-7805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKADA",
        "first_name": "VINCENT",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "OH",
            "license": "35.120432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD13019",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.