Individual provider Active NPI

Emy Mary Kuriakose, M.D.

  • Pediatric Cardiology Physician
  • Grand Rapids, MI
National Provider Identifier
1467734442
Registry record updated Nov 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
4301109026 Issued in MI
Practice address
25 Michigan St NE
Suite 4300
Grand Rapids, MI 49503
Phone
(616) 267-9150
Fax
(616) 267-1408
NPI assigned
Sep 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 4301109026 MI Primary

Addresses

Primary practice location

25 Michigan St NE
Suite 4300
Grand Rapids, MI 49503

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, TX2 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
I20150914000459 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 7618284324 Reassigns benefits to 1 organization
I20210806002053 TX Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 7618284324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Cardiovascular Disease (Cardiology)
Education
State University of New York at Stony Brook, School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Childrens Physician GroupGroup PAC ID 4385722081, 661 clinicians

Practice addresses (Care Compare)

6651 Main St
Houston, TX 77030-2351
Phone (832) 826-3000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301109026MIMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children'S Physician Group CurrentSince Jul 30, 2021 Accepting new patients

Locations

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

6621 Fannin St
#W1998
Houston, TX 77030

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

101 W Expressway 83
McAllen, TX 78503
Phone (956) 661-9840

6651 Main St
Va Hospital, TX 77030
Phone (832) 826-3000

Interoperability endpoints

  • Direct secure messaging: ekuriakose360650@prddirect.texaschildrens.org
  • Direct secure messaging: ekuriakose217760@direct.stlukeshealth.org

Organizations & group practices 2

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": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1467734442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE",
            "address_2": "SUITE 4300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-267-9150",
            "fax_number": "616-267-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURIAKOSE",
        "first_name": "EMY",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MI",
            "license": "4301109026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.