Individual provider Active NPI

Kinner A Mehta, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Vestal, NY
National Provider Identifier
1376702035
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
248318 Issued in NY
Practice address
1020 Vestal Pkwy E
Vestal, NY 13850-1748
Phone
(607) 754-5342
Fax
(607) 754-5508
NPI assigned
Jun 6, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 064603 GA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 248318 NY Primary

Addresses

Primary practice location

1020 Vestal Pkwy E
Vestal, NY 13850-1748

Mailing address

1020 Vestal Pkwy E
Vestal, NY 13850-1748
Phone (607) 754-5342

Other identifiers 1

IdentifierTypeStateIssuer
03045732MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kinner.mehta@direct.lourdes.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20081117000506 NY Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3678633989 Reassigns benefits to 1 organization
I20101220000754 GA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3678633989 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital Inc. Current Accepting new patients
The Southeast Permanente Medical Group CurrentSince Nov 29, 2010 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Sep 9, 2013 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Sep 9, 2013 Accepting new patients
Chemung Medical Services PC Past Accepting new patients
Fort Edward Rescue Squad Inc Past Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

3101 Shippers Rd
Vestal, NY 13850
Phone (607) 250-2180

1020 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 444-6868

Organizations & group practices 7

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": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1376702035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 VESTAL PKWY E",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501748",
            "telephone_number": "607-754-5342",
            "fax_number": "607-754-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 VESTAL PKWY E",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501748",
            "telephone_number": "607-754-5342",
            "fax_number": "607-754-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "KINNER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "GA",
            "license": "064603",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "248318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03045732",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kinner.mehta@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3101 Shippers Rd",
            "city": "Vestal",
            "state": "NY",
            "country_code": "US",
            "postal_code": "138502080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Vestal, NY

Sources for this page

Verify at the official NPI Registry.