Vijay Kumar Kannam, M.D.
Individual provider Active NPI Family Medicine Physician · Gravette, AR
NPI 1699039610 · NPPES record last updated Oct 16, 2023
Key facts
- NPI
- 1699039610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-9316 (AR)
- Practice address
- 1101 Jackson St SW
Gravette, AR 72736-9121 - Phone
- (479) 787-5221
- Fax
- (479) 787-5613
- NPI assigned
- Jun 25, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 16
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sgoh Acquisition Inc
Practice addresses (Care Compare)
102 Russell Rd
Rogers, AR 72756-9319
Phone (479) 278-7189
Hospital & facility affiliations
- Ozarks Community Hospital of Gravette
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160225002279 | AR | Practitioner - Family Practice | 5799080982 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sgoh Acquisition Inc | Current |
Accepting new patients | |
| Sgoh Acquisition Inc | Current |
Accepting new patients |
Locations
1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221
102 Russell Rd
Rogers, AR 72756
Phone (479) 278-7189
Interoperability endpoints
- vkannam@ochhospital.hin.us
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E-9316 | AR | Yes |
Addresses
Primary practice location
1101 Jackson St SW
Gravette, AR 72736-9121
Mailing address
1101 Jackson St SW
Gravette, AR 72736-9121
Phone (479) 787-5221
Other practice location 1
102 Russell Rd
Rogers, AR 72756-9319
Phone (479) 278-7189
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | VKANNAM@OCHHOSPITAL.HIN.US | ||
| Direct Messaging Address | VKANNAM@OCHHOSPITAL.HIN.US |
Other providers in Gravette, AR
- Hayden Huett
- Addyson Hujtyn
- Amelia Dee Jackson
- Nancy L Jones
- Anita Marie Kane
- Amber Michelle Karr
- Heidi Knipple
- Kristi L Kroona
- Tamra T Lamer
- Linnberry Wellness Center PLLC
All providers in Gravette, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.