NPIMap

Individual provider Active NPI

Jayadevan Kundumadathil, MD

  • Internal Medicine Physician
  • Indialantic, FL
National Provider Identifier
1912968918
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME78547 Issued in FL
Practice address
406 5TH Ave
Indialantic, FL 32903-4280
Phone
(321) 473-8974
Fax
(321) 473-8976
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME78547 FL Primary

Addresses

Primary practice location

406 5TH Ave
Indialantic, FL 32903-4280

Mailing address

406 5TH Ave
Indialantic, FL 32903-4280
Phone (321) 473-8974

Other identifiers 2

IdentifierTypeStateIssuer
110205422OtherRAIL ROAD MEDICARE
258183300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100809000232 FL Practitioner - Internal Medicine 6204969413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jay Medical PLLCGroup PAC ID 8022141233, 2 clinicians

Practice addresses (Care Compare)

406 5TH Ave
Indialantic, FL 32903-4280
Phone (321) 473-8974

Hospital & facility affiliations

  • Health First Home Care Home health agency, Melbourne, FL, CCN 107233
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
  • Viera Hospital Hospital, Melbourne, FL, CCN 100315

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME78547FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jay Medical PLLC Internal Medicine CurrentSince Jul 1, 2010 Accepting new patients
Osler Medical Inc Past Accepting new patients

Locations

406 5th Ave
Indialantic, FL 32903
Phone (321) 473-8974

Interoperability endpoints

  • Direct secure messaging: jkundumadathil23003@epicdirect.hf.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/BAGHAD

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 8

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1912968918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 5TH AVE",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329034280",
            "telephone_number": "321-473-8974",
            "fax_number": "321-473-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 5TH AVE",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329034280",
            "telephone_number": "321-473-8974",
            "fax_number": "321-473-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNDUMADATHIL",
        "first_name": "JAYADEVAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME78547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "110205422",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258183300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indialantic, FL

Sources for this page

Verify at the official NPI Registry.