NPIMap

Individual provider Active NPI

Premkumar Raja, MD

  • Radiation Oncology Physician
  • Charleston, WV
National Provider Identifier
1689631442
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
21336 Issued in WV
Practice address
3415 Maccorkle Ave SE
Charleston, WV 25304-1334
Phone
(304) 388-1790
Fax
(304) 388-1795
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 21336 WV Primary

Addresses

Primary practice location

3415 Maccorkle Ave SE
Charleston, WV 25304-1334

Mailing address

PO Box 896158
Charlotte, NC 28289-6158
Phone (304) 388-1790

Other identifiers 1

IdentifierTypeStateIssuer
2006367000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20031204000511 WV Practitioner - Radiation Oncology 1153226907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Virginia School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charleston Radiation Therapy Consultants PLLCGroup PAC ID 4688579428, 4 clinicians

Practice addresses (Care Compare)

3415 Maccorkle Ave SE
Charleston, WV 25304-1334
Phone (304) 388-1790

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.64 of 100Reported as individual
Quality
73.61
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21336WVMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Radiation Therapy Consultants PLLC Radiation Oncology CurrentSince Nov 1, 2003 Accepting new patients

Locations

3415 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-1790

Interoperability endpoints

  • Direct secure messaging: praja2@ahfs.direct.varian.com

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.

Hospital & facility affiliations 12

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1689631442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896158",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896158",
            "telephone_number": "304-388-1790",
            "fax_number": "304-388-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041334",
            "telephone_number": "304-388-1790",
            "fax_number": "304-388-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJA",
        "first_name": "PREMKUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "WV",
            "license": "21336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2006367000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.