Active NPI
Abraham C Kuruvilla, MD
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1831139922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12557
- Practice address
- 2525 E Roosevelt St
Phoenix, AZ 85008-4948 - Phone
- (602) 344-1015
- Fax
- (602) 344-1174
- NPI assigned
- Jun 7, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12557 | AZ | Primary |
Addresses
Primary practice location
2525 E Roosevelt St
Phoenix, AZ 85008-4948
Mailing address
2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222678 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12557 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Family Medicine | Past | Accepting new patients |
Locations
2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015
3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520
2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043
Interoperability endpoints
- akuruvilla446@direct.valleywisehealth.org
Organizations & group practices 3
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.
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-
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- NPI 1528396108
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485820800000",
"number": "1831139922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 E THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850168034",
"telephone_number": "602-470-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 E ROOSEVELT ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850084948",
"telephone_number": "602-344-1015",
"fax_number": "602-344-1174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KURUVILLA",
"first_name": "ABRAHAM",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2017-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "12557",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "222678",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.