Supreme Medical P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

222728 Issued in NY

Legal business name

SUPREME MEDICAL P.C.

Practice address

100 N Belle Mead Rd
Suite D
East Setauket, NY 11733-3530

Phone

(631) 751-8905

Fax

(631) 751-8908

NPI assigned

Dec 6, 2006

Last updated

Mar 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Anjani Venkata Kota, M.DNPI 1720055353

Title

President

Phone

(631) 751-8905

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anjani Kota, M.D.

  • Internal Medicine Physician
  • East Setauket, NY
  • NPI 1720055353
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393804800000",
    "number": "1902965171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N BELLE MEAD RD",
            "address_2": "SUITE D",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333530",
            "telephone_number": "631-751-8905",
            "fax_number": "631-751-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N BELLE MEAD RD",
            "address_2": "SUITE D",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333530",
            "telephone_number": "631-751-8905",
            "fax_number": "631-751-8908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2014-03-03",
        "status": "A",
        "authorized_official_last_name": "KOTA",
        "authorized_official_first_name": "ANJANI",
        "authorized_official_middle_name": "VENKATA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-751-8905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "222728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Heesuck Suh, M.D.
• Edward Sun, MD
• Raeysha Surendran, MS, ATC
• Howard Sussman, M.D.
• Suzanne J. Ennis Edd, LCSW, P.C.
• Satu M Svoboda, NP-C
• Donna M Sweeney, MS

• Internal Medicine Physician in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.