Pratheek Simon Kakkasseril, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

35.120203 Issued in OH

Practice address

1001 Belmont Ave
Youngstown, OH 44504-1003

Phone

(330) 747-1106

Fax

(330) 747-0491

NPI assigned

May 28, 2010

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 OH

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

Vascular Surgery

Education

Northeastern Ohio University College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health Physicians Youngstown Specialty Care LLCGroup PAC ID 3476950296, 463 clinicians

Ohio Wound Care Associates LLCGroup PAC ID 7719393032, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Expand Health Skilled at Home LLC Home health agency, Youngstown, OH, CCN 369312
• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064
• HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276
• MH St Joseph Warren Hospital Hospital, Warren, OH, CCN 360161
• Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pkakkasseril60399@direct.bsmhealth.org

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.

• Mercy Health Physicians Youngstown Specialty Care LLC

  • Surgery Physician
  • Youngstown, OH
  • NPI 1649892225
  Medicare reassignment Care Compare group NPD
• Ohio Wound Care Associates LLC

  • Internal Medicine Physician
  • North Royalton, OH
  • NPI 1659965457

  Vascular Surgery

  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians Youngstown, LLC

  • Family Medicine Physician
  • Youngstown, OH
  • NPI 1154636066
  Medicare reassignment NPD
• Mercy Health Physicians Youngstown LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1750920245
  NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1386316107
  NPD
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  NPD (past)

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

• Expand Health Skilled at Home LLC

  • Home Health Agency
  • Youngstown, OH
  • NPI 1548936156
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Warren, OH
  • NPI 1538233309

  Hospital

  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Warren, OH
  • NPI 1629009964
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1790868982
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  Care Compare affiliation

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

{
    "created_epoch": "1275004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1609195643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041003",
            "telephone_number": "330-747-1106",
            "fax_number": "330-747-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041003",
            "telephone_number": "330-747-1106",
            "fax_number": "330-747-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKKASSERIL",
        "first_name": "PRATHEEK",
        "middle_name": "SIMON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-28",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OH",
            "license": "35.120203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0078791",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H152570",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Kaczmark
• Ose Kadiri
• Puspa Raj Kafley
• Joseph Kahrig
• Daraspreet Singh Kainth, MD
• Traci A Kalafut, CDCA, QMHS
• Joshua Charles Kale, CT
• Lauren Kaleel
• Caitlin Kalman, AGACNP-BC
• David Michael Kalman, CRNA

• Vascular Surgery Physician in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Vascular Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.