Individual provider Active NPI

Soumya Kondaveety

  • Internal Medicine Physician
  • Canton, OH
National Provider Identifier
1316564768
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35147626 Issued in OH
Practice address
1320 Mercy Dr NW
Canton, OH 44708-2614
Phone
(330) 489-1000
NPI assigned
Jul 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35147626 OH Primary

Addresses

Primary practice location

1320 Mercy Dr NW
Canton, OH 44708-2614

Mailing address

1320 Mercy Dr NW
Canton, OH 44708-2614
Phone (330) 489-1000

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
I20230926002737 OH Practitioner - Internal Medicine 1759735624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of Richland County, LTDGroup PAC ID 4284538430, 54 clinicians

Practice addresses (Care Compare)

1320 Mercy Dr NW
Canton, OH 44708-2614
Phone (330) 489-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35147626OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Richland County, LTD Internal Medicine CurrentSince Sep 1, 2023 Accepting new patients
Cleveland Clinic Mercy Hospital Past Accepting new patients

Locations

1320 Timken Mercy Dr NW
Canton, OH 44708
Phone (330) 489-1000

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

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.

Hospital & facility affiliations 2

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": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1316564768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDAVEETY",
        "first_name": "SOUMYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35147626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.