Individual provider Active NPI

Kiran Kumar Kanjerla, MD

  • Student in an Organized Health Care Education/Training Program
  • Washington, DC
National Provider Identifier
1871813873
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
MTL004823 Issued in DC
Practice address
The GW Medical Faculty Associates
2150 Pennsylvania Ave , NW
Washington, DC 20037
Phone
(202) 741-3000
NPI assigned
Jun 2, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MTL004823 DC Primary

Addresses

Primary practice location

The GW Medical Faculty Associates
2150 Pennsylvania Ave , NW
Washington, DC 20037

Mailing address

The GW Medical Faculty Associates
2150 Pennsylvania Ave , NW
Washington, DC 20037
Phone (202) 741-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20250321000059 WV Practitioner - Cardiovascular Disease (Cardiology) 0648792416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

122 12TH St
Princeton, WV 24740-2312
Phone (304) 487-7936

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MTL004823DCMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Princeton Community Hospital Assn., Inc CurrentSince Feb 11, 2025 Accepting new patients
Princeton Community Hospital Assn Inc. CurrentSince Feb 11, 2025 Accepting new patients

Locations

401 E Vermillion St
Athens, WV 24712
Phone (304) 384-7325

122 12th St
Princeton, WV 24740
Phone (304) 487-7061

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": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1871813873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "THE GW MEDICAL FACULTY ASSOCIATES",
            "address_2": "2150 PENNSYLVANIA AVE , NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20037",
            "telephone_number": "202-741-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THE GW MEDICAL FACULTY ASSOCIATES",
            "address_2": "2150 PENNSYLVANIA AVE , NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20037",
            "telephone_number": "202-741-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANJERLA",
        "first_name": "KIRAN",
        "middle_name": "KUMAR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-02",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "DC",
            "license": "MTL004823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.