Active NPI
Paul D Kanakaraj, MD
- Surgery Physician
- Rifle, CO
National Provider Identifier
1790731255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- DR42252
- Practice address
- 501 Airport Rd
Rifle, CO 81650-8510 - Phone
- (970) 625-1100
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | DR42252 | CO | Primary |
Addresses
Primary practice location
501 Airport Rd
Rifle, CO 81650-8510
Mailing address
501 Airport Rd
Rifle, CO 81650-8510
Phone (970) 625-1100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29638259 | Medicaid | CO |
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 |
|---|---|---|---|
| DR42252 | CO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1790731255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 AIRPORT RD",
"city": "RIFLE",
"state": "CO",
"postal_code": "816508510",
"telephone_number": "970-625-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 AIRPORT RD",
"city": "RIFLE",
"state": "CO",
"postal_code": "816508510",
"telephone_number": "970-625-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANAKARAJ",
"first_name": "PAUL",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "DR42252",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "29638259",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rifle, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.