Individual provider Active NPI

Prabhakar Kocherlakota, MD

  • Neonatal-Perinatal Medicine Physician
  • Newburgh, NY
National Provider Identifier
1326035031
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
240081 Issued in NY
Practice address
70 Dubois St
Newburgh, NY 12550-4851
Phone
(914) 493-8558
Fax
(914) 493-1488
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 240081 NY Primary

Addresses

Primary practice location

70 Dubois St
Newburgh, NY 12550-4851

Mailing address

22 Saw Mill River Rd
2ND Floor
Hawthorne, NY 10532-1533
Phone (914) 593-1606

Other identifiers 1

IdentifierTypeStateIssuer
01783664MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150731016958 NY Practitioner - Pediatric Medicine 5597079715 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Children's Health Physicians, LLP Neonatal-Perinatal Medicine CurrentSince Jan 1, 2014 Accepting new patients
Boston Childrens Health Physicians LLP CurrentSince Jan 1, 2014 Accepting new patients
St. Luke's Cornwall Hospital Past Accepting new patients

Locations

22 Saw Mill River Rd
Ste 2
Hawthorne, NY 10532
Phone (914) 593-1606

19 Bradhurst Ave
Hawthorne, NY 10532
Phone (914) 493-7235

70 Dubois St
Newburgh, NY 12550
Phone (845) 534-4673

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1326035031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 SAW MILL RIVER RD",
            "address_2": "2ND FLOOR",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105321533",
            "telephone_number": "914-593-1606",
            "fax_number": "914-593-1790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 DUBOIS ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125504851",
            "telephone_number": "914-493-8558",
            "fax_number": "914-493-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCHERLAKOTA",
        "first_name": "PRABHAKAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "240081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01783664",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, NY

Sources for this page

Verify at the official NPI Registry.