Individual provider Active NPI

Krishnakanthan Sasankan, M.D.

  • Pediatrics Physician
  • Gainesville, FL
National Provider Identifier
1649269689
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME161851 Issued in FL
Practice address
1600 SW Archer Rd
Gainesville, FL 32610-5102
Phone
(352) 265-0111
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 193354 NY
Pediatrics Physician 208000000X ME161851 FL Primary

Addresses

Primary practice location

1600 SW Archer Rd
Gainesville, FL 32610-5102

Mailing address

PO Box 100296
Gainesville, FL 32610-3003
Phone (352) 627-9350

Other identifiers 6

IdentifierTypeStateIssuer
000523039005OtherNYBC/BS
00010157703OtherNYUNIVERA
01439409MedicaidNY
040426002481OtherNYFIDELIS
1209766OtherNYIHA
143850DLOtherNYPREFERRED CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080611000073 NY Practitioner - Pediatric Medicine 6507937000 Reassigns benefits to 2 organizations
I20240105000148 FL Practitioner - Pediatric Medicine 6507937000 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME161851FLMDPediatrics Physician
193354NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Dec 28, 2023 Accepting new patients
Mercy Hospital of Buffalo CurrentSince Aug 1, 2016 Accepting new patients
Sisters of Charity Hospital of Buffalo New York CurrentSince Dec 1, 2017 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Dec 28, 2023 Accepting new patients
Sisters of Charity Hospital of Buffalo New York CurrentSince Dec 1, 2017 Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501

Interoperability endpoints

  • Direct secure messaging: ksasankan@pedsurgentcare.medentdirect.com
  • Direct secure messaging: ksasankan657946@direct.shands.ufl.edu

Organizations & group practices 5

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": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1649269689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100296",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-627-9350",
            "fax_number": "352-273-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326105102",
            "telephone_number": "352-265-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SASANKAN",
        "first_name": "KRISHNAKANTHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "193354",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME161851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000523039005",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010157703",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01439409",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426002481",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "1209766",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "143850DL",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.