Pavan Kolluri, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

36831 Issued in KY

Practice address

204 Talcott Ridge Rd
South Windsor, CT 06074-2394

Phone

(860) 648-4032

Fax

(260) 407-8004

NPI assigned

Jul 9, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Emergency Medicine

Education

University of Missouri, Kansas City, School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Fairview Emergency Physicians LLCGroup PAC ID 5799034799, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• King'S Daughters' Medical Center Hospital, Ashland, KY, CCN 180009

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as virtual group

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• West Fairview Emergency Physicians LLC

  • Emergency Medicine Physician
  • Ashland, KY
  • NPI 1578060331
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ashland Hospital Corporation

  • General Acute Care Hospital
  • Ashland, KY
  • NPI 1851346720
  Care Compare affiliation

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224028800000",
    "number": "1477586428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 TALCOTT RIDGE RD",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742394",
            "telephone_number": "860-648-4032",
            "fax_number": "260-407-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 TALCOTT RIDGE RD",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742394",
            "telephone_number": "860-648-4032",
            "fax_number": "260-407-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLURI",
        "first_name": "PAVAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2008-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "36831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64036676",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "930109200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Leavey Kmetz, LPC, MA
• Knights Touch LLC
• Valerie M. Knorr, M.A.
• Diane Knox, LMFT
• Angela Koehnke, LMFT
• Meenakshi Ranjith Kotcherlakota, FNP-C
• Kayla Koza, PA-C
• James R Kratzke, LMSW
• Raymond Charles Kurker, MD
• Eric Michael Kusher, D.C.

• Emergency Medicine Physician in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Emergency Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.