NPIMap

Individual provider Active NPI

Krishna Chaitanya Kottapalli, MD

  • Internal Medicine Physician
  • Melrose Park, IL
National Provider Identifier
1952678286
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125057310 Issued in IL
Practice address
1225 W Lake St
Melrose Park, IL 60160-4039
Phone
(708) 344-2161
NPI assigned
Dec 1, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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 60973 WI
Internal Medicine Physician 207R00000X 125057310 IL Primary

Addresses

Primary practice location

1225 W Lake St
Melrose Park, IL 60160-4039

Mailing address

260 E Butterfield Rd
Apt 406
Elmhurst, IL 60126-4581
Phone (405) 334-3979

Other practice location 1

36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-1000

Other identifiers 1

IdentifierTypeStateIssuer
100031574MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20131007000296 WI Practitioner - Internal Medicine 4486888484 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Physician Group, Wisconsin LLCGroup PAC ID 2466840004, 2 clinicians

Practice addresses (Care Compare)

19333 W N Ave
Brookfield, WI 53045-4132
Phone (262) 780-4111

3200 S 103Rd St
Milwaukee, WI 53227-4104
Phone (678) 967-5599

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125057310ILMDInternal Medicine Physician
60973WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Jul 1, 2018 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine CurrentSince Sep 20, 2022 Accepting new patients
Impact Physician Group, Wisconsin LLC Internal Medicine CurrentSince Jun 29, 2022 Accepting new patients
Baycare Aurora, LLC CurrentSince Sep 20, 2022 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Jul 1, 2018 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Jul 22, 2013 Accepting new patients
Fort Healthcare, Inc. CurrentSince Oct 3, 2023 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 20, 2022 Accepting new patients
Fort Healthcare Inc Current Accepting new patients
Fort Healthcare Inc CurrentSince Oct 3, 2023 Accepting new patients
Sacred Heart Rehabilitation Institute, Inc. PastSince Jun 21, 2022 Accepting new patients

Locations

19333 W North Ave
Brookfield, WI 53045
Phone (262) 785-2000

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000

3200 S 103rd St
Milwaukee, WI 53227
Phone (414) 440-0500

36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Interoperability endpoints

  • Direct secure messaging: kkottapalli694809@direct.froedtert.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
  • Direct secure messaging: kirshma.kottapalli@direct.forthc.com

Organizations & group practices 11

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 7

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": "1322697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1952678286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 E BUTTERFIELD RD",
            "address_2": "APT 406",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601264581",
            "telephone_number": "405-334-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W LAKE ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601604039",
            "telephone_number": "708-344-2161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36500 Aurora Dr",
            "address_purpose": "LOCATION",
            "city": "Summit",
            "state": "WI",
            "postal_code": "530664899",
            "country_code": "US",
            "telephone_number": "262-434-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTTAPALLI",
        "first_name": "KRISHNA CHAITANYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-01",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "60973",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125057310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100031574",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose Park, IL

Sources for this page

Verify at the official NPI Registry.