Individual provider Active NPI

John Draugel Kannengieser, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • West Islip, NY
National Provider Identifier
1447515465
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
006700 Issued in NY
Practice address
1111 Montauk Hwy
Ste 100
West Islip, NY 11795-4910
Phone
(631) 422-4450
NPI assigned
Jul 5, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 006700 NY Primary

Addresses

Primary practice location

1111 Montauk Hwy
Ste 100
West Islip, NY 11795-4910

Mailing address

1111 Montauk Hwy
Ste 100
West Islip, NY 11795-4910
Phone (631) 422-4450

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150401000738 NY Practitioner - Podiatry 5597082578 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Island Foot and AnkleGroup PAC ID 4587841119, 9 clinicians

Practice addresses (Care Compare)

1111 Montack Hwy
West Islip, NY 11795-4910
Phone (631) 422-4450

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue254
Removal of skin lesions52
Removal of nail tissue1809
Removal or shaving of skin growth1816
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006700NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Sun River Health Inc. CurrentSince Jul 20, 2015 Accepting new patients
Island Foot and Ankle Foot & Ankle Surgery CurrentSince Jul 1, 2015 Accepting new patients
Island Foot and Ankle Foot & Ankle Surgery CurrentSince Jul 1, 2015 Accepting new patients
Sun River Health Inc Current Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

207 Broadway
Amityville, NY 11701
Phone (631) 264-1910

1399 Franklin Ave
Ste 304
Garden City, NY 11530
Phone (516) 248-9680

1037 Main St
Peekskill, NY 10566
Phone (914) 734-8800

952 Roanoke Ave
Riverhead, NY 11901
Phone (631) 422-4450

30 Hempstead Ave
Ste 158
Rockville Ctr, NY 11570
Phone (516) 764-6800

6144 Route 25A
Ste 14
Wading River, NY 11792
Phone (631) 707-8771

1111 Montauk Hwy
West Islip, NY 11795
Phone (631) 422-2700

1111 Montauk Hwy
Ste 100
West Islip, NY 11795
Phone (631) 376-4163

Interoperability endpoints

  • Direct secure messaging: jkannengieser69124@northwell.direct-ci.com

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": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1447515465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MONTAUK HWY",
            "address_2": "STE 100",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954910",
            "telephone_number": "631-422-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MONTAUK HWY",
            "address_2": "STE 100",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954910",
            "telephone_number": "631-422-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNENGIESER",
        "first_name": "JOHN",
        "middle_name": "DRAUGEL",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "006700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

Verify at the official NPI Registry.