Individual provider Active NPI

Jayanthi Kini, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Springfield, OR
National Provider Identifier
1801975925
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD152979 Issued in OR
Practice address
123 International Way
Springfield, OR 97477-1047
Phone
(541) 341-8063
Fax
(541) 341-8099
NPI assigned
Nov 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD00038975 WA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD152979 OR Primary

Addresses

Primary practice location

123 International Way
Springfield, OR 97477-1047

Mailing address

123 International Way
Springfield, OR 97477-1047
Phone (541) 341-8063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180301001027 AR Practitioner - Pathology 1355237058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Services Laboratory PAGroup PAC ID 0840373411, 5 clinicians

Practice addresses (Care Compare)

1430 W 'C' St
Russellville, AR 72801-2805

1430 W C St
Russellville, AR 72811-0925
Phone (479) 968-6781

PO Box
Suite 925
Russellville, AR 72811-0925

Hospital & facility affiliations

  • National Park Medical Center Hospital, Hot Springs, AR, CCN 040078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD152979ORMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Services Laboratory PA Anatomic Pathology & Clinical Pathology CurrentSince Jan 21, 2018 Accepting new patients
Pathology Services Laboratory PA Anatomic Pathology & Clinical Pathology Current Accepting new patients

Locations

1430 W C St
Russellville, AR 72801
Phone (479) 968-6781

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1801975925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 INTERNATIONAL WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771047",
            "telephone_number": "541-341-8063",
            "fax_number": "541-341-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 INTERNATIONAL WAY",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771047",
            "telephone_number": "541-341-8063",
            "fax_number": "541-341-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINI",
        "first_name": "JAYANTHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD00038975",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OR",
            "license": "MD152979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.