NPIMap

Individual provider Active NPI

Nandheesha Hanumanthappa, MD

  • Nephrology Physician
  • Port Charlotte, FL
National Provider Identifier
1609195833
Registry record updated Sep 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME116075 Issued in FL
Practice address
3221 Tamiami TRL
Port Charlotte, FL 33952-8002
Phone
(941) 505-8720
Fax
(941) 505-8747
NPI assigned
May 27, 2010
Last updated
Sep 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME116075 FL Primary

Addresses

Primary practice location

3221 Tamiami TRL
Port Charlotte, FL 33952-8002

Mailing address

3221 Tamiami TRL
Port Charlotte, FL 33952-8002
Phone (941) 505-8720

Other identifiers 2

IdentifierTypeStateIssuer
P01197128OtherFLRR MEDICARE
14R6ZOtherFLBCFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20130711000494 FL Practitioner - NephrologyPractitioner - Internal Medicine 0446490627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Tufts University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

18669 Tamiami TRL
North Port, FL 34287-7388
Phone (941) 505-8720

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.7 of 100Reported as individual
Quality
77.64
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Kidney Physicians , LLC Nephrology CurrentSince Dec 18, 2021 Accepting new patients
Florida Kidney Physicians, LLC Nephrology CurrentSince Dec 18, 2021 Accepting new patients

Locations

1150 N 35th Ave
Ste 620
Hollywood, FL 33021
Phone (954) 612-8173

19056 NE 29th Ave
Miami, FL 33180
Phone (305) 354-4558

18669 Tamiami Trl
North Port, FL 34287
Phone (941) 423-5035

18669 Tamiami Trl
Ste A
North Port, FL 34287

2852 Tamiami Trl
Ste 1
Port Charlotte, FL 33952

3221 Tamiami Trl
Pt Charlotte, FL 33952

12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4
  • Direct secure messaging: nandheesha.hanumanthappa.1@15644.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1609195833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528002",
            "telephone_number": "941-505-8720",
            "fax_number": "941-505-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528002",
            "telephone_number": "941-505-8720",
            "fax_number": "941-505-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANUMANTHAPPA",
        "first_name": "NANDHEESHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-27",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME116075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01197128",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCFL",
            "identifier": "14R6Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.