NPIMap

Individual provider Active NPI

Anjani Kota, M.D.

  • Internal Medicine Physician
  • East Setauket, NY
National Provider Identifier
1720055353
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
222728-1 Issued in NY
Practice address
100 N Belle Mead Ave Ste D
East Setauket, NY 11733-3530
Phone
(631) 751-8905
Fax
(631) 751-8908
NPI assigned
Mar 2, 2006
Last updated
Jun 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 222728-1 NY Primary

Addresses

Primary practice location

100 N Belle Mead Ave Ste D
East Setauket, NY 11733-3530

Mailing address

100 N Belle Mead Ave Ste D
East Setauket, NY 11733-3530
Phone (631) 751-8905

Other practice location 1

2500 Nesconset Hwy
Stony Brook, NY 11790-2553
Phone (631) 751-8905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20041005001331 NY Practitioner - Internal Medicine 7214996289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

100 N Belle Mead Ave
Suite D
East Setauket, NY 11733-3530
Phone (631) 751-8905

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
222728-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Supreme Medical P.C. Internal Medicine CurrentSince Aug 24, 2004 Accepting new patients
Terryville Medical Associates Past Accepting new patients
Premier Surgical PLLC Past Accepting new patients

Locations

100 N Belle Mead Ave
Ste D
East Setauket, NY 11733
Phone (631) 751-8905

2500 Nesconset Hwy
Bldg 12B
Stony Brook, NY 11790
Phone (631) 246-5454

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/40521fdf-a90b-4eb2-b8bc-77e90b0288d6/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1720055353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N BELLE MEAD AVE STE D",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333530",
            "telephone_number": "631-751-8905",
            "fax_number": "631-751-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N BELLE MEAD AVE STE D",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333530",
            "telephone_number": "631-751-8905",
            "fax_number": "631-751-8908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Nesconset Hwy",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117902553",
            "country_code": "US",
            "telephone_number": "631-751-8905",
            "fax_number": "631-751-8908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTA",
        "first_name": "ANJANI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-02",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "222728-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.