Active NPI
Chitra Kuthiala, M.D.
- Allergy & Immunology Physician
- Jacksonville, FL
National Provider Identifier
1700898434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 29708
- Practice address
- 9765 San Jose Blvd
Jacksonville, FL 32257-4402 - Phone
- (904) 262-9135
- NPI assigned
- Aug 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 29708 | FL | Primary |
| Allergy & Immunology Physician | 207K00000X | 021322 | GA |
Addresses
Primary practice location
9765 San Jose Blvd
Jacksonville, FL 32257-4402
Mailing address
9765 San Jose Blvd
Jacksonville, FL 32257-4402
Phone (904) 262-9135
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 279638 | Other | FL | AVMED |
| 42736 | Other | FL | BLUE CROSS BLUE SHIELD |
| 2699245 | Other | FL | AETNA |
| 192665 | Other | FL | HEALTHEASE |
| 3464796-01 | Other | FL | CIGNA |
| 192665 | Other | FL | WELLCARE |
| 265658200 | Medicaid | FL |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021322 | GA | MD | Pharmacist |
| 29708 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1700898434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9765 SAN JOSE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322574402",
"telephone_number": "904-262-9135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9765 SAN JOSE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322574402",
"telephone_number": "904-262-9135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTHIALA",
"first_name": "CHITRA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "FL",
"license": "29708",
"primary": true
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "GA",
"license": "021322",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "279638",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "42736",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2699245",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHEASE",
"identifier": "192665",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3464796-01",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "192665",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "265658200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.