NPIMap

Individual provider Active NPI

Gitanjli Channan, MD

  • Family Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1336146570
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35070585 Issued in OH
Practice address
4631 Ridge Ave
Ste. B
Cincinnati, OH 45209-1028
Phone
(513) 631-1268
Fax
(513) 366-4121
NPI assigned
Jul 1, 2005
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35070585 OH Primary

Addresses

Primary practice location

4631 Ridge Ave
Ste. B
Cincinnati, OH 45209-1028

Mailing address

4631 Ridge Ave
Ste. B
Cincinnati, OH 45209-1028
Phone (513) 631-1268

Other identifiers 2

IdentifierTypeStateIssuer
P00856774OtherOHMEDICARE RR
2032919MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gchannan1693@direct.thechristhospital.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210802000745 FL Practitioner - Family Practice 6709883820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

660 Glades Rd
Suite 140
Boca Raton, FL 33431-6466
Phone (561) 447-7737

7015 Beracasa Way
Boca Raton, FL 33433-3453
Phone (561) 939-2033

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35070585OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Channan MD PA Family Medicine CurrentSince Aug 31, 2021 Accepting new patients
Deaconess Healthcare Services Co Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

660 Glades Rd
Ste 140
Boca Raton, FL 33431
Phone (561) 447-7737

Interoperability endpoints

  • Direct secure messaging: gitanjli.channan.1@24260.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1336146570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4631 RIDGE AVE",
            "address_2": "STE. B",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452091028",
            "telephone_number": "513-631-1268",
            "fax_number": "513-366-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4631 RIDGE AVE",
            "address_2": "STE. B",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452091028",
            "telephone_number": "513-631-1268",
            "fax_number": "513-366-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANNAN",
        "first_name": "GITANJLI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35070585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00856774",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2032919",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gchannan1693@direct.thechristhospital.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4631 Ridge Ave",
            "address_2": "Ste. B",
            "city": "Cincinnati",
            "state": "OH",
            "country_code": "US",
            "postal_code": "452091028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.