NPIMap

Individual provider Active NPI

Kasturi Etukuru, M.D.,

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1912117300
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08605300 Issued in NJ
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(718) 818-2526
NPI assigned
May 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 244886 NY
Internal Medicine Physician 207R00000X 25MA08605300 NJ Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

355 Bard Ave
Apt#6G
Staten Island, NY 10310-1664
Phone (718) 701-0043

Other practice location 1

1 Clara Maass Dr
Belleville, NJ 07109-3550
Phone (732) 937-8939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NJ2 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
I20111123000221 NC Practitioner - Internal Medicine 3870688609
I20151023001552 NJ Practitioner - Internal Medicine 3870688609 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Plover Inpatient Services LLCGroup PAC ID 1355561663, 158 clinicians

Practice addresses (Care Compare)

1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.07 of 100Reported as group
Quality
76.5
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
39.14 of 100Reported as individual
Quality
30
Improvement activities
0
Cost
58.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
244886NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rwjbh Observation Associates LLC Internal Medicine CurrentSince May 20, 2021 Accepting new patients
Vidant Medical Group LLC CurrentSince Nov 5, 2018 Accepting new patients
Etukuru MD PC Internal Medicine CurrentSince Feb 11, 2024 Accepting new patients
Rwjbh Emergency Medicine Associates, LLC Internal Medicine CurrentSince May 20, 2021 Accepting new patients
Vidant Medical Group LLC CurrentSince Nov 5, 2018 Accepting new patients
Richmond University Medical Center Past Accepting new patients
HMH Hospitals Corporation Past Accepting new patients

Locations

2310 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 847-6611

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

100 Airport Rd
Kinston, NC 28501
Phone (252) 522-7000

1 Clara Maass Dr
Belleville, NJ 07109
Phone (973) 450-2008

225 Williamson St
Elizabeth, NJ 07202
Phone (908) 994-5204

600 River Ave
Lakewood, NJ 08701
Phone (732) 363-1900

1001 Center St
Little Egg Harbor Twp, NJ 08087
Phone (609) 294-4261

3 Executive Dr
Ste 400
Somerset, NJ 08873
Phone (732) 369-5949

110 Rehill Ave
Somerville, NJ 08876
Phone (908) 429-5833

1 Hamilton Health Pl
Trenton, NJ 08690
Phone (609) 584-6763

Organizations & group practices 8

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 9

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1912117300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "APT#6G",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-701-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2526"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Clara Maass Dr",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "NJ",
            "postal_code": "071093550",
            "country_code": "US",
            "telephone_number": "732-937-8939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETUKURU",
        "first_name": "KASTURI",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "244886",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08605300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.