Individual provider Active NPI

Venkatarama Rao Koppaka, M.D.

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1790866333
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
248397-1 Issued in NY
Practice address
151 W 17TH St Apt 2C
New York, NY 10011-5427
Phone
(347) 387-4214
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101058482 VA
Pulmonary Disease Physician 207RP1001X 0101058482 VA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 0101058482 VA
Pulmonary Disease Physician 207RP1001X 248397-1 NY
Pulmonary Disease Physician 207RP1001X 248397 NY
Internal Medicine Physician 207R00000X 248397-1 NY Primary
Internal Medicine Physician 207R00000X 248397 NY

Addresses

Primary practice location

151 W 17TH St Apt 2C
New York, NY 10011-5427

Mailing address

151 W 17TH St Apt 2C
New York, NY 10011-5427
Phone (347) 387-4214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
248397NYMDInternal Medicine Physician
248397-1NYMDInternal Medicine Physician
0101058482VAMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians PastSince Sep 28, 2021 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1790866333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 W 17TH ST APT 2C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100115427",
            "telephone_number": "347-387-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 W 17TH ST APT 2C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100115427",
            "telephone_number": "347-387-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPAKA",
        "first_name": "VENKATARAMA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101058482",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "VA",
            "license": "0101058482",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "VA",
            "license": "0101058482",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "248397-1",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "248397",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "248397-1",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "248397",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.