Individual provider Active NPI

Krishna Chaitanya Cherukuri, M.D.

  • Interventional Cardiology Physician
  • Carbondale, IL
National Provider Identifier
1487096962
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
036153082 Issued in IL
Practice address
409 W Oak St
Carbondale, IL 62901-1464
Phone
(618) 529-4455
Fax
(618) 351-1287
NPI assigned
Jul 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036153082 IL
Interventional Cardiology Physician 207RI0011X 036153082 IL Primary

Addresses

Primary practice location

409 W Oak St
Carbondale, IL 62901-1464

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other practice location 1

900 N Washington St Ste 2
Du Quoin, IL 62832-1233
Phone (618) 529-4455

Other practice location 2

217 S Park Ave Ste 2
Herrin, IL 62948-3611
Phone (618) 529-4455

Other practice location 3

3905 W Ernestine Dr
Marion, IL 62959-5800
Phone (618) 529-4455

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address kcherukrui40205@sih.direct-ci.com
Direct Messaging Address kcherukrui40205@sih.direct-ci.com
Direct Messaging Address kcherukrui40205@sih.direct-ci.com
Direct Messaging Address kcherukrui40205@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MA2 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
I20200921002874 IL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 3173811718 Reassigns benefits to 1 organization
I20241211000739 MA Practitioner - Internal MedicinePractitioner - Interventional Cardiology 3173811718 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036153082ILMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP Internal Medicine CurrentSince Aug 10, 2020 Accepting new patients
Saint Vincent Physician Services, Inc. Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients

Locations

201 Bailey Ln
Benton, IL 62812
Phone (618) 438-3113

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

409 W Oak St
Carbondale, IL 62901
Phone (618) 536-2565

900 N Washington St
Ste 2
Du Quoin, IL 62832

217 S Park Ave
Ste 2
Herrin, IL 62948

3905 W Ernestine Dr
Marion, IL 62959
Phone (573) 331-5761

123 Summer St
Worcester, MA 01608
Phone (508) 363-6000

123 Summer St
Ste 284
Worcester, MA 01608

123 Summer St
#273
Worcester, MA 01608
Phone (508) 363-6327

Interoperability endpoints

  • Direct secure messaging: krishna.cherukuri.1@626.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Interventional Cardiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Vincent Physician Services Inc 71 clinicians

Practice addresses (Care Compare)

123 Summer St
Worcester, MA 01608-1216
Phone (508) 363-5000

Hospital & facility affiliations

  • St Vincent Hospital Hospital, Worcester, MA, CCN 220176
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Athol Memorial Hospital Hospital, Athol, MA, CCN 221303
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019

Merit-based Incentive Payment System (MIPS)

Final score
82 of 100Reported as group
Quality
55.9
Promoting interoperability
100
Improvement activities
40
Cost
72.01

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1487096962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011464",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N Washington St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Du Quoin",
            "state": "IL",
            "postal_code": "628321233",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "217 S Park Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483611",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3905 W Ernestine Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629595800",
            "country_code": "US",
            "telephone_number": "618-529-4455",
            "fax_number": "618-351-1287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHERUKURI",
        "first_name": "KRISHNA CHAITANYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-24",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036153082",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036153082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcherukrui40205@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "409 W Oak St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcherukrui40205@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "3905 W Ernestine Dr",
            "city": "Marion",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629595800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcherukrui40205@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "900 N Washington St Ste 2",
            "city": "Du Quoin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628321233",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcherukrui40205@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "217 S Park Ave Ste 2",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.