Sushanth Nayak, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD473059 Issued in PA

Practice address

11000 Roosevelt Blvd Unit 360
Philadelphia, PA 19116-3961

Phone

(215) 677-1475

Fax

(215) 677-3082

NPI assigned

Jun 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OR

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

Family Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peacehealth Medical Group Cottage GroveGroup PAC ID 9436060530, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Cottage Grove Community Medical Center Hospital, Cottage Grove, OR, CCN 381301

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: snayak62066@direct.peacehealth.org
• Direct secure messaging: snayak1201043@wm.providencedirect.org

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.

• Peacehealth Medical Group Cottage Grove

  • Multi-Specialty Clinic/Center
  • Creswell, OR
  • NPI 1780631267
  Medicare reassignment Care Compare group
• Peacehealth

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391
  Medicare reassignment NPD
• Peacehealth

  • Multi-Specialty Clinic/Center
  • Florence, OR
  • NPI 1982774378
  Medicare reassignment
• Temple Physicians Inc

  • Family Medicine Physician
  • Flourtown, PA
  • NPI 1952642936
  NPD (past)
• Peacehealth

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187

  Family Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Peacehealth

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391
  Care Compare affiliation

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1710273958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-926-9022",
            "fax_number": "215-226-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 ROOSEVELT BLVD UNIT 360",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163961",
            "telephone_number": "215-677-1475",
            "fax_number": "215-677-3082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 College St SE",
            "address_purpose": "LOCATION",
            "city": "Lacey",
            "state": "WA",
            "postal_code": "985034389",
            "country_code": "US",
            "telephone_number": "360-486-2900",
            "fax_number": "360-486-2901",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1620 Cooper Point Rd SW",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985025736",
            "country_code": "US",
            "telephone_number": "360-486-6710",
            "fax_number": "360-705-0614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAYAK",
        "first_name": "SUSHANTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60662834",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD473059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snayak1201043@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4800 College St SE",
            "city": "Lacey",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985034389",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snayak1201043@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1620 Cooper Point Rd SW",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985025736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lavanya Nawlakhe
• John Eugene Nawn, M.D.
• Anupma Nayak, MD
• Arth Praveen Nayak
• Nisha Nayak, PH.D.
• Tara Nayak, ND
• Ameya Pramod Nayate, MD
• Ebru Nayci, MD
• Laura Naydovich, MD
• Naykas Healthcare NP Family Medicine

• Family Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.