Individual provider Active NPI

Somasekhara Rao Mukkamala, M.D.

  • Anesthesiology Physician
  • Williamsville, NY
National Provider Identifier
1568482693
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
134365-1 Issued in NY
Practice address
30 S Cayuga Rd
Williamsville, NY 14221-6728
Phone
(716) 632-1088
Fax
(716) 632-7842
NPI assigned
Jul 20, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 134365-1 NY Primary

Addresses

Primary practice location

30 S Cayuga Rd
Williamsville, NY 14221-6728

Mailing address

30 S Cayuga Rd
Williamsville, NY 14221-6728
Phone (716) 632-1088

Other identifiers 1

IdentifierTypeStateIssuer
00581613MedicaidNY

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080325000481 NY Practitioner - Anesthesiology 9133205578

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1970
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

30 S Cayuga Rd
Williamsville, NY 14221-6706

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
134365-1NYMDAnesthesiology Physician

Hospital & facility affiliations 6

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1568482693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S CAYUGA RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216728",
            "telephone_number": "716-632-1088",
            "fax_number": "716-632-7842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S CAYUGA RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216728",
            "telephone_number": "716-632-1088",
            "fax_number": "716-632-7842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKAMALA",
        "first_name": "SOMASEKHARA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "134365-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00581613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.