NPIMap

Individual provider Active NPI

Bishan Chakravarty, M.D.

  • Nephrology Physician
  • Farmington, MO
National Provider Identifier
1790030195
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2018009371 Issued in MO
Practice address
703 Maple Valley Drive
Farmington, MO 63640
Phone
(573) 701-0470
Fax
(573) 701-0473
NPI assigned
Jul 21, 2012
Last updated
Aug 23, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2018009371 MO
Nephrology Physician 207RN0300X 2018009371 MO Primary

Addresses

Primary practice location

703 Maple Valley Drive
Farmington, MO 63640

Mailing address

703 Maple Valley Drive
Farmington, MO 63640
Phone (573) 701-0470

Other identifiers 1

IdentifierTypeStateIssuer
200052190MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SD, MN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180530001273 MO Practitioner - NephrologyPractitioner - Internal Medicine 8729377445 Reassigns benefits to 1 organization
I20230914002871 SD Practitioner - Nephrology 8729377445 Reassigns benefits to 1 organization
I20241224001344 MN Practitioner - Nephrology 8729377445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avera McKennanGroup PAC ID 0345157103, shared by 52 NPIs, 957 clinicians

Practice addresses (Care Compare)

1018 6TH Ave
Worthington, MN 56187-2202
Phone (507) 372-2941

110 S Logan Ave
Suite a
Gregory, SD 57533-1614
Phone (605) 835-9611

1216 Ryans Rd
Worthington, MN 56187-1722
Phone (507) 372-2921

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

310 22ND Ave
Brookings, SD 57006-2474

400 Park Ave
Gregory, SD 57533-1302
Phone (605) 835-8394

4500 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 322-9777

4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-5000

810 E 23Rd St
Sioux Falls, SD 57105-2135

911 5TH Ave SW
Pipestone, MN 56164-1054
Phone (507) 825-5811

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018009371MOMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Aug 1, 2023 Accepting new patients
Avera McKennan CurrentSince Nov 1, 2024 Accepting new patients
Avera McKennan Nephrology CurrentSince Aug 1, 2023 Accepting new patients
Amin Nephrology and Hypertension Specialists, Inc Nephrology CurrentSince Jul 1, 2018 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Internal Medicine Past Accepting new patients

Locations

911 5th Ave SW
Pipestone, MN 56164
Phone (507) 825-5811

703 Maple Valley Dr
Farmington, MO 63640
Phone (573) 701-0470

725 Maple Valley Dr
#B
Farmington, MO 63640
Phone (573) 701-0470

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

810 E 23rd St
Ste 403
Sioux Falls, SD 57105
Phone (605) 322-5800

Interoperability endpoints

  • Direct secure messaging: bishan.chakravarty@avera.sdhealthlink.net
  • FHIR API: https://fhir4.healow.com/fhir/r4/DEFGAA

Organizations & group practices 6

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 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1342828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1790030195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 MAPLE VALLEY DRIVE",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "63640",
            "telephone_number": "573-701-0470",
            "fax_number": "573-701-0473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 MAPLE VALLEY DRIVE",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "63640",
            "telephone_number": "573-701-0470",
            "fax_number": "573-701-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAKRAVARTY",
        "first_name": "BISHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-21",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2018009371",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2018009371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200052190",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.