NPIMap

Individual provider Active NPI

Kalyan Chakravarthy Kanneganti, M.D

  • Gastroenterology Physician
  • Tacoma, WA
National Provider Identifier
1578769303
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD60783086 Issued in WA
Practice address
1112 6TH Ave Ste 200
Tacoma, WA 98405-4048
Phone
(253) 272-8664
Fax
(253) 874-6089
NPI assigned
Jun 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 002851 NY
Gastroenterology Physician 207RG0100X 002851 NY
Gastroenterology Physician 207RG0100X Q0286 TX
Gastroenterology Physician 207RG0100X MD60783086 WA Primary

Addresses

Primary practice location

1112 6TH Ave Ste 200
Tacoma, WA 98405-4048

Mailing address

1112 6TH Ave Ste 200
Tacoma, WA 98405-4048
Phone (253) 272-8664

Other identifiers 1

IdentifierTypeStateIssuer
2096205MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkanneganti261098@fhsce.catholichealth.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180410002810 WA Practitioner - GastroenterologyPractitioner - Internal Medicine 9436242039 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1112 6TH Ave
Suite 200
Tacoma, WA 98405-4048
Phone (253) 272-8664

11567 Canterwood Blvd NW
Gig Harbor, WA 98332-5812
Phone (253) 426-6341

1812 S J St
Suite 120
Tacoma, WA 98405-4965
Phone (253) 428-2200

4700 Point Fosdick Dr NW
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy169
Upper gastrointestinal (GI) endoscopy for acid reflux201

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Internal Medicine CurrentSince Mar 3, 2018 Accepting new patients
Franciscan Medical Group CurrentSince Mar 3, 2018 Accepting new patients
Franciscan Medical Group Past Accepting new patients

Locations

1112 6th Ave
Ste 200
Tacoma, WA 98405
Phone (253) 445-5750

6002 Westgate Blvd
Ste 230
Tacoma, WA 98406
Phone (253) 761-2244

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

11311 Bridgeport Way SW
Ste 207
Tacoma, WA 98499

Interoperability endpoints

  • Direct secure messaging: kkanneganti259115@achce.catholichealth.net

Organizations & group practices 4

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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1578769303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 6TH AVE STE 200",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054048",
            "telephone_number": "253-272-8664",
            "fax_number": "253-874-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 6TH AVE STE 200",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054048",
            "telephone_number": "253-272-8664",
            "fax_number": "253-874-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNEGANTI",
        "first_name": "KALYAN",
        "middle_name": "CHAKRAVARTHY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "002851",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "002851",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "Q0286",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD60783086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2096205",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkanneganti261098@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1112 6th Ave Ste 200",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.