Suresh Kandavanam, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

TRN23599 Issued in FL

Practice address

201 N Clyde Morris Blvd
Suite 200
Daytona Beach, FL 32114-2724

Phone

(386) 425-4165

Fax

(386) 425-7545

NPI assigned

Jun 27, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

General Practice

Education

University of Oklahoma College of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ormond Medical ArtsGroup PAC ID 1254222565, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4
• Direct secure messaging: suresh.kandavanam.1@15135.direct.athenahealth.com

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.

• Ormond Medical Arts Family Practice LLC

  dba Complete Health

  • Family Medicine Physician
  • Ormond Beach, FL
  • NPI 1326254962
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1689025009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 200",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142724",
            "telephone_number": "386-254-4165",
            "fax_number": "386-254-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 200",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142724",
            "telephone_number": "386-425-4165",
            "fax_number": "386-425-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDAVANAM",
        "first_name": "SURESH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN23599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Kamel, MD
• Susan Kamelgarn, ARNP
• Joseph M Kaminski, M.D.
• Hannah Kamphaus
• Cristi Lynn Kamps, M.A.
• Kristina Kangas, OTR/L
• Susan Kangethe, PHARMD
• Cecilia Vaneesha Karemingi, MD
• Cara J Karner, R.D.
• Madison Kaufman

• Family Medicine Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.