NPIMap

Individual provider Active NPI

Charles Chanan Kanner, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Brooklyn, NY
National Provider Identifier
1831301332
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
208405 Issued in NY
Practice address
3015- West 29TH Street
Brooklyn, NY 11224
Phone
(718) 266-5700
NPI assigned
May 4, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 208405 NY Primary

Addresses

Primary practice location

3015- West 29TH Street
Brooklyn, NY 11224

Mailing address

881- East 24TH Street
Brooklyn, NY 11210
Phone (718) 951-3349

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110502000694 NY Practitioner - Geriatric MedicinePractitioner - Internal MedicinePractitioner - Hospice/Palliative Care 9739364043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Hospice/Palliative Care, Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shorefront Operating LLCGroup PAC ID 1456570704, 2 clinicians

Practice addresses (Care Compare)

3015 W 29TH St
Brooklyn, NY 11224-1901
Phone 7182665700218

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
208405NYMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shorefront Operating LLC CurrentSince Sep 1, 2015 Accepting new patients
Willoughby Rehabilitation and Health Care Center LLC Past Accepting new patients

Locations

3015 W 29th St
Brooklyn, NY 11224
Phone (718) 266-5700

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Seagate Rehabilitation and Nursing CenterBrooklyn, NY, CCN 335513 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 4, 2001
Mar 4, 2001

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Shorefront Operating LLC

    dba Seagate Rehabilitation and Health Care Center

    • Skilled Nursing Facility
    • Brooklyn, NY
    • NPI 1801206156

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831301332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881- EAST 24TH STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11210",
            "telephone_number": "718-951-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015- WEST 29TH STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11224",
            "telephone_number": "718-266-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNER",
        "first_name": "CHARLES",
        "middle_name": "CHANAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "208405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.