Mahesh Bommaraju, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

190900 Issued in NY

Practice address

1540 Maple Rd
Williamsville, NY 14221-3647

Phone

(716) 878-7662

NPI assigned

Mar 2, 2006

Last updated

Jan 11, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Kaleida Health

  dba Buffalo General Hospital

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1639209596
  Medicare reassignment NPD
• University at Buffalo Pediatric Associates Inc

  • Pediatrics Physician
  • Buffalo, NY
  • NPI 1912928599
  Medicare reassignment NPD
• Kaleida Health

  dba Millard Fillmore Suburban Hospital

  • General Acute Care Hospital
  • Williamsville, NY
  • NPI 1053441907
  NPD
• Kaleida Health

  dba Kaleida Health Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Buffalo, NY
  • NPI 1992540546
  NPD

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263168000000",
    "number": "1457328114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 BRYANT ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142222006",
            "telephone_number": "716-878-7673",
            "fax_number": "716-878-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647",
            "telephone_number": "716-878-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMARAJU",
        "first_name": "MAHESH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2010-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "190900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "3610082",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426000926",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01564185",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000523290004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010018901",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hartwig O Boepple, M.D.
• Thomas B Bogner, M.D.
• Kiran Bojedla, D.O.
• Gina M Boldt, L.M.T
• Kevin Bolger, DDS
• Alicia R Bommersbach, PHYSICIAN ASSISTANT
• Stephanie Bona, LPN
• Tracey Bonafede
• Annamarie Boncore, LPN
• Linda A Bonczyk, LMHC

• Neonatal-Perinatal Medicine Physician in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Neonatal-Perinatal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2010; 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.