Mamatha Sundaresh, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

190550 Issued in NY

Practice address

4802 10TH Ave
Brooklyn, NY 11219-2844

Phone

(718) 283-7500

Fax

(718) 635-7235

NPI assigned

Sep 19, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 9

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: mamathasundaresh@mai.allscriptsdirect.net

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.

• Good Samaritan Hospital Medical Center

  • Physician Assistant
  • West Islip, NY
  • NPI 1518901180
  Medicare reassignment NPD
• Jamaica Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Jamaica, NY
  • NPI 1477505220
  Medicare reassignment NPD
• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment NPD
• MMC Pediatrics Faculty Practice

  • Pediatrics Physician
  • Brooklyn, NY
  • NPI 1285648154
  Medicare reassignment NPD
• Nassau Health Care Corporation

  • General Acute Care Hospital
  • East Meadow, NY
  • NPI 1902822992
  Medicare reassignment NPD
• Samaritan Emergency Medical Services, PC

  • Emergency Medicine Physician
  • West Islip, NY
  • NPI 1104978014
  Medicare reassignment NPD
• Good Samaritan Hospital Medical

  • Critical Care Medicine (Internal Medicine) Physician
  • West Islip, NY
  • NPI 1548501620
  NPD
• Jamaica Hospital

  • Skilled Nursing Facility
  • Jamaica, NY
  • NPI 1750516795
  NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• Island Emergency Medical Services, P.C.

  • Emergency Medicine Physician
  • Far Rockaway, NY
  • NPI 1639160385
  NPD (past)

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360022400000",
    "number": "1629063318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "977 48TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192919",
            "telephone_number": "718-283-8015",
            "fax_number": "718-635-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192844",
            "telephone_number": "718-283-7500",
            "fax_number": "718-635-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARESH",
        "first_name": "MAMATHA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2013-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "190550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01480813",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON HEALTHCARE NY",
            "identifier": "11-3563769",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4604933",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P2163738",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST",
            "identifier": "190550-F15",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2698609",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC HMO",
            "identifier": "2563948",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "300950401",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "BK00828-03",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sundance Sadc, Inc.
• Kavya Gnana Sundar, MD
• Ramaswami P Sundar, MD
• Krishnamurthi Sundaram, M.D.
• Revathy Sundaram, MD
• Shree Sundaresh, MD
• Sunday Adult Daycare Center Inc
• Anna Larisa Lawyer Sunderland, MSN, CNM, WHNP-BC
• Gabriella Sunderland
• Katherine A Sundstrom, M.D.

• Pediatrics Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.