NPIMap

Individual provider Active NPI

Kannan Sivaraju

  • Geriatric Medicine (Internal Medicine) Physician
  • Verona, NJ
National Provider Identifier
1659508687
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
25MA08777500 Issued in NJ
Practice address
271 Grove Ave Ste a
Verona, NJ 07044-1731
Phone
(973) 239-2600
Fax
(833) 495-1921
NPI assigned
Jun 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 25MA08777500 NJ Primary

Addresses

Primary practice location

271 Grove Ave Ste a
Verona, NJ 07044-1731

Mailing address

271 Grove Ave Ste E
Verona, NJ 07044-1730
Phone (973) 559-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20110418000682 NJ Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Osteopathic Manipulative MedicinePractitioner - Geriatric Medicine 1254524655 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine, Internal Medicine, Osteopathic Manipulative Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vanguard Medical Group PAGroup PAC ID 5092751842, 59 clinicians
Vanguard North Haledon and Oakland PAGroup PAC ID 8022248012, 4 clinicians

Practice addresses (Care Compare)

271 Grove Ave
Suite a
Verona, NJ 07044-1731
Phone (973) 239-2600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care for the Homebound PA CurrentSince Mar 19, 2021 Accepting new patients

Locations

271 Grove Ave
Ste A
Verona, NJ 07044
Phone (973) 239-2600

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25493/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kannan.sivaraju.2@25493.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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1659508687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 GROVE AVE STE E",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441730",
            "telephone_number": "973-559-3700",
            "fax_number": "833-484-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 GROVE AVE STE A",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441731",
            "telephone_number": "973-239-2600",
            "fax_number": "833-495-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVARAJU",
        "first_name": "KANNAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-17",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA08777500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Verona, NJ

Sources for this page

Verify at the official NPI Registry.