Individual provider Active NPI

Venkat Krishna Rajasurya, M.D., MPH

  • Pulmonary Disease Physician
  • Winston Salem, NC
National Provider Identifier
1669601662
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD61034745 Issued in WA
Practice address
3001 Lyndhurst Ave
Winston Salem, NC 27103
Phone
(336) 765-0383
Fax
(336) 760-6918
NPI assigned
Jul 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036-130003 IL
Pulmonary Disease Physician 207RP1001X 201900047 NC
Pulmonary Disease Physician 207RP1001X MD61034745 WA Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 201900047 NC

Addresses

Primary practice location

3001 Lyndhurst Ave
Winston Salem, NC 27103

Mailing address

3001 Lyndhurst Ave
Winston Salem, NC 27103-4007
Phone (336) 765-0383

Other practice location 1

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-4200

Other practice location 2

3001 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 765-0383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20200721000109 WA Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 6709192305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

202 N Division St
Auburn, WA 98001-4939

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

311 S L St
Tacoma, WA 98405-3720

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-1962

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

  • Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079
  • Multicare Auburn Medical Center Hospital, Auburn, WA, CCN 500015
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • Multicare Covington Medical Center Hospital, Covington, WA, CCN 500154

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201900047NCMDCritical Care Medicine (Internal Medicine) Physician
MD61034745WAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jul 6, 2020 Accepting new patients
Multicare Health System CurrentSince Jul 6, 2020 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Past Accepting new patients
Multicare Health System Past Accepting new patients
Multicare Health System Past Accepting new patients
Multicare Health System Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: vrajasurya489986@direct.multicare.org

Organizations & group practices 7

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 4

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": "1247270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1669601662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 N Edward St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625264163",
            "country_code": "US",
            "telephone_number": "217-876-4200",
            "fax_number": "217-876-4209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3001 Lyndhurst Ave",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "27103",
            "country_code": "US",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAJASURYA",
        "first_name": "VENKAT KRISHNA",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-11",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-130003",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "201900047",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WA",
            "license": "MD61034745",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "201900047",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.