Active NPI
Venkatarama Rao Koppaka, M.D.
- Internal Medicine Physician
- New York, NY
National Provider Identifier
1790866333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 248397-1
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 248397 | NY | MD | Internal Medicine Physician |
| 248397-1 | NY | MD | Internal Medicine Physician |
| 0101058482 | VA | MD | Critical Care Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCV Associated Physicians | Past | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.