NPIMap

Individual provider Active NPI

Jaikumar Ravunniarath Menon, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Poughkeepsie, NY
National Provider Identifier
1427000934
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
251537 Issued in NY
Practice address
38 Wildwood Dr
Poughkeepsie, NY 12603
Phone
(845) 594-8895
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 251537 NY Primary

Addresses

Primary practice location

38 Wildwood Dr
Poughkeepsie, NY 12603

Mailing address

38 Wildwood Dr
Poughkeepsie, NY 12603
Phone (845) 594-8895

Other identifiers 2

IdentifierTypeStateIssuer
363260OtherNYMVP
000002544MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20041228000313 NY Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9436117173 Reassigns benefits to 3 organizations
Practice locations: Poughkeepsie, NY

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ion Oltean Physician PCGroup PAC ID 6406990860, 8 clinicians

Practice addresses (Care Compare)

22 Robert R Kasin Way
Beacon, NY 12508-1559
Phone (845) 831-8704

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
24.7 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
82.35

Merit-based Incentive Payment System (MIPS)

Final score
94.73 of 100Reported as group
Quality
88.19
Improvement activities
40
Cost
64.85

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001808NYMDMental Health Counselor
251537NYMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peyman Younesi MD PLLC CurrentSince Jan 1, 2025 Accepting new patients
Jaikumar Ravunniarath Medical P.C. CurrentSince May 1, 2019 Accepting new patients
Ion Oltean Physician PC CurrentSince Oct 17, 2024 Accepting new patients
My Medical PC CurrentSince Jan 1, 2025 Accepting new patients
Mid Hudson Physicians, P.C. Past Accepting new patients
Lutheran Center at Poughkeepsie, Inc Past Accepting new patients
Atlanticare Management LLC Past Accepting new patients

Locations

3438 Bell Blvd
Ste 301
Bayside, NY 11361

22 Robert R Kasin Way
Beacon, NY 12508
Phone (845) 231-5792

147 2nd Ave
Brentwood, NY 11717
Phone (631) 273-7204

2830 Pitkin Ave
Brooklyn, NY 11208
Phone (347) 420-8295

838 Fair St
Carmel, NY 10512
Phone (718) 892-6600

8008 45th Ave
Flushing, NY 11373
Phone (718) 373-0777

46 Harriman Dr
Goshen, NY 10924
Phone (845) 291-3700

9131 175th St
Jamaica, NY 11432
Phone (340) 709-3133

172 Meadow Hill Rd
Newburgh, NY 12550
Phone (410) 499-1437

822 Cedar Ave
Niagara Falls, NY 14301
Phone (716) 272-1207

5 Church St
Spencerport, NY 14559
Phone (585) 352-4810

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
New Paltz Center for Rehabilitation and NursingNew Paltz, NY, CCN 335188 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 17, 2018
Dec 17, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • CLR New Paltz LLC

    dba New Paltz Center for Rehabilitation and Nursing

    • Skilled Nursing Facility
    • New Paltz, NY
    • NPI 1225565955

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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.

Hospital & facility affiliations 10

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1427000934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 WILDWOOD DR",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-594-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 WILDWOOD DR",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-594-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENON",
        "first_name": "JAIKUMAR",
        "middle_name": "RAVUNNIARATH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "251537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "363260",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000002544",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.