NPIMap

Individual provider Active NPI

Naganna Channaveeraiah, M.D, MBA, CPE

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1801983390
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
276303 Issued in NY
Practice address
121 Dekalb Ave
Brooklyn, NY 11201
Phone
(718) 455-9000
Fax
(718) 452-6112
NPI assigned
Oct 6, 2006
Last updated
May 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME123689 FL
Family Medicine Physician 207Q00000X 276303 NY Primary

Addresses

Primary practice location

121 Dekalb Ave
Brooklyn, NY 11201

Mailing address

2021 Professional Center Dr Ste 100
Orange Park, FL 32073-4461
Phone (904) 688-3000

Other identifiers 1

IdentifierTypeStateIssuer
1801983390MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, GA2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20190723000901 NE Practitioner - Family Practice 3971666280 Reassigns benefits to 1 organization
I20260209002684 GA Practitioner - Emergency Medicine 3971666280 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Health Care SystemsGroup PAC ID 3274528989, 27 clinicians
Southland Dodge Emergency Medical Services, LLCGroup PAC ID 8224360805, 12 clinicians

Practice addresses (Care Compare)

300 N Columbia Ave
Seward, NE 68434-2299
Phone (402) 643-2971

901 Griffin Ave
Eastman, GA 31023-6720
Phone (478) 448-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.6 of 100Reported as apm
Quality
82.13
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Health Care Systems CurrentSince Jun 21, 2019 Accepting new patients
Memorial Health Care Systems Single Specialty CurrentSince Jun 21, 2019 Accepting new patients
Georgia Emergency Group, LLC Single Specialty CurrentSince Jan 1, 2026 Accepting new patients

Locations

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

1050 McDonough Rd
Jackson, GA 30233
Phone (770) 775-7861

250 N Columbia Ave
Seward, NE 68434
Phone (402) 643-4800

300 N Columbia Ave
Seward, NE 68434
Phone (402) 643-2971

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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 2

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1801983390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 PROFESSIONAL CENTER DR STE 100",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734461",
            "telephone_number": "904-688-3000",
            "fax_number": "904-688-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "718-455-9000",
            "fax_number": "718-452-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANNAVEERAIAH",
        "first_name": "NAGANNA",
        "credential": "M.D, MBA, CPE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME123689",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "276303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801983390",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.