Active NPI
Kavisya Cherukuri
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1679035570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 317465
- Practice address
- 257 Flatbush Ave
Brooklyn, NY 11217-1066 - Phone
- (718) 838-9445
- Fax
- (212) 202-7988
- NPI assigned
- Apr 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 317465 | NY | Primary |
Addresses
Primary practice location
257 Flatbush Ave
Brooklyn, NY 11217-1066
Mailing address
257 Flatbush Ave
Brooklyn, NY 11217-1066
Phone (718) 838-9445
Other practice location 1
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-6562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 317465 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maimonides Medical Center | Current | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
Interoperability endpoints
- kavisyacherukuri@mai.allscriptsdirect.net
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Brooklyn, NY
- NPI 1093777492
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1679035570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "257 FLATBUSH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112171066",
"telephone_number": "718-838-9445",
"fax_number": "212-202-7988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "257 FLATBUSH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112171066",
"telephone_number": "718-838-9445",
"fax_number": "212-202-7988"
}
],
"practiceLocations": [
{
"address_1": "2500 N State St",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MS",
"postal_code": "392164500",
"country_code": "US",
"telephone_number": "601-984-6562",
"fax_number": "601-918-2086",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHERUKURI",
"first_name": "KAVISYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-01",
"last_updated": "2022-06-27",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "317465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.