Kalyani Theivanayagam, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA06857500 Issued in NJ

Practice address

276 Woodland Ave
Summit, NJ 07901-1437

Phone

(973) 669-8181

Fax

(973) 669-1687

NPI assigned

Aug 17, 2006

Last updated

Dec 23, 2010By the provider in NPPES

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Internal Medicine

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Manickam Ganesh MD PAGroup PAC ID 8921053224, 2 clinicians

State of New Jersey Omb Centralized PayrollGroup PAC ID 6406742592, 129 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cooperman Barnabas Medical Center Hospital, Livingston, NJ, CCN 310076

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ktheivanayagam254403@epicdirect.rwjbh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Manickam Ganesh M.D., P.a.

  • Internal Medicine Physician
  • West Orange, NJ
  • NPI 1831384486
  Medicare reassignment Care Compare group NPD
• State of New Jersey Omb Centralized Payroll

  dba Greystone Park Psychiatric Hospital

  • Psychiatric Hospital
  • Morris Plains, NJ
  • NPI 1336221878
  Medicare reassignment Care Compare group NPD
• Cooperman Barnabas Medical Center Inc

  • General Acute Care Hospital
  • Livingston, NJ
  • NPI 1396857488
  NPD (past)

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

• Cooperman Barnabas Medical Center Inc

  • General Acute Care Hospital
  • Livingston, NJ
  • NPI 1396857488
  Care Compare affiliation

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293062400000",
    "number": "1598878910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 WOODLAND AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079011437",
            "telephone_number": "973-669-8181",
            "fax_number": "973-669-1687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 WOODLAND AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079011437",
            "telephone_number": "973-669-8181",
            "fax_number": "973-669-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIVANAYAGAM",
        "first_name": "KALYANI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2010-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06857500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7878109",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Summit, NJ
• Providers in Summit, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; 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.