Rene Kukkamalla

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

56420 Issued in KY

Practice address

1221 S Broadway
Lexington, KY 40504-2701

Phone

(859) 258-4000

Fax

(859) 258-6203

NPI assigned

Apr 20, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Clark Emergency Physicians

  • Emergency Medicine Physician
  • Winchester, KY
  • NPI 1346781499
  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382
  Medicare reassignment NPD

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1417344136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6200",
            "fax_number": "859-258-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-4000",
            "fax_number": "859-258-6203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 E Roosevelt St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850084973",
            "country_code": "US",
            "telephone_number": "404-735-0387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUKKAMALLA",
        "first_name": "RENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-20",
        "last_updated": "2023-05-01",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "56420",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R6033",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Alan Kuerzi Jr.
• Caleb Osei Kufour, PHARMD
• Matthew Kuhl, APRN
• Melinda Anderson Kuhnhenn
• Christina Rae Kuhrau, MD
• Taylor Kulik, MD
• Hanesh Kumar, M.D.
• Ritesh Kumar, MD
• Shyanie Kumar, M.D.
• Amartya Kundu, MBBS

• Emergency Medicine Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.