NPIMap

Individual provider Active NPI

Ajay Chakravarthy Kanakamedala, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Easton, PA
National Provider Identifier
1477040616
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
MD485258 Issued in PA
Practice address
250 S 21St St
Easton, PA 18042-3851
Phone
(484) 526-1735
NPI assigned
Apr 13, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD485258 PA Primary

Addresses

Primary practice location

250 S 21St St
Easton, PA 18042-3851

Mailing address

250 S 21St St
Easton, PA 18042-3851
Phone (484) 526-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240815002536 PA Practitioner - Sports Medicine 9739427147 Reassigns benefits to 2 organizations
I20240821001575 NJ Practitioner - Orthopedic Surgery 9739427147 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
University of Pittsburgh School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians
St Lukes Warren Physician Group PCGroup PAC ID 9739093675, 374 clinicians

Practice addresses (Care Compare)

1872 St Lukes Blvd
Easton, PA 18045-5669
Phone (484) 526-7800

250 S 21St St
Easton, PA 18042-3851

701 Ostrum St
Fountain Hill, PA 18015-1153

755 Memorial Pkwy
Phillipsburg, NJ 08865-2748
Phone (484) 503-0055

801 Ostrm St
Bethlehem, PA 18015-1000

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Bethlehem, PA, CCN 390049
  • St Luke'S Hospital - Easton Campus Hospital, Easton, PA, CCN 390162
  • St Luke'S Warren Hospital Hospital, Phillipsburg, NJ, CCN 310060

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)14
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Physician Group, Inc. Current Accepting new patients
St Luke'S Physician Group Inc CurrentSince Sep 16, 2024 Accepting new patients
St. Luke'S Physician Group, Inc. CurrentSince Sep 16, 2024 Accepting new patients
St. Luke'S Warren Physician Group, PC CurrentSince Sep 16, 2024 Accepting new patients
St. Luke'S Warren Physician Group, PC Current Accepting new patients
St. Luke'S Warren Physician Group, PC CurrentSince Sep 16, 2024 Accepting new patients
Gslpg, Inc CurrentSince Sep 16, 2024 Accepting new patients
St. Luke'S Physician Group, Inc Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

185 Roseberry St
Bldg 2ND
Phillipsburg, NJ 08865
Phone (908) 847-2619

755 Memorial Pkwy
Ste 201
Phillipsburg, NJ 08865
Phone (484) 503-0055

279 State Route 31 S
Washington, NJ 07882
Phone (908) 689-2201

250 S 21st St
Easton, PA 18042
Phone (610) 250-4300

701 Ostrum St
Ste 602
Fountain Hill, PA 18015
Phone (610) 807-9400

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

100 Paramount Blvd
Orwigsburg, PA 17961
Phone (272) 639-1000

Interoperability endpoints

  • Direct secure messaging: akanakamedala327684@direct-sluhn.org

Organizations & group practices 9

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 8

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": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1477040616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S 21ST ST",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180423851",
            "telephone_number": "484-526-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S 21ST ST",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180423851",
            "telephone_number": "484-526-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANAKAMEDALA",
        "first_name": "AJAY",
        "middle_name": "CHAKRAVARTHY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-13",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "MD485258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, PA

Sources for this page

Verify at the official NPI Registry.