Individual provider Active NPI

Kavitha Krishnamani, M.D.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1629196282
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59825 Issued in AZ
Practice address
3815 E Bell Rd Ste 4100
Phoenix, AZ 85032-2167
Phone
(602) 633-3848
Fax
(602) 633-3841
NPI assigned
Mar 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00047733 WA
Student in an Organized Health Care Education/Training Program 390200000X ML20008124 WA
Family Medicine Physician 207Q00000X 59825 AZ Primary

Addresses

Primary practice location

3815 E Bell Rd Ste 4100
Phoenix, AZ 85032-2167

Mailing address

3815 E Bell Rd Ste 2200
Phoenix, AZ 85032-2139
Phone (602) 633-3848

Other identifiers 1

IdentifierTypeStateIssuer
149726MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20220902001206 AZ Practitioner - Family Practice 3072653401 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59825AZMDFamily Medicine Physician
ML20008124WAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group Arizona LLC Family Medicine CurrentSince Aug 16, 2022 Accepting new patients
George Stecyk M.D.,P.C. Past Accepting new patients
Privia Medical Group Arizona, LLC Family Medicine Past Accepting new patients

Locations

5620 W Thunderbird Rd
Ste F1
Glendale, AZ 85306
Phone (602) 938-6960

14541 W Indian School Rd
#600
Goodyear, AZ 85395
Phone (623) 535-5599

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1629196282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 2200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322139",
            "telephone_number": "602-633-3848",
            "fax_number": "602-633-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 4100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322167",
            "telephone_number": "602-633-3848",
            "fax_number": "602-633-3841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAMANI",
        "first_name": "KAVITHA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00047733",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "ML20008124",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "59825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149726",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.