NPIMap

Individual provider Active NPI

Gauthami Reddy Churukanti, M.D.

  • Urology Physician
  • Stony Brook, NY
National Provider Identifier
1962763219
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD460958 Issued in PA
Practice address
101 Nicolls Rd # Hsct9040
Stony Brook, NY 11794-8265
Phone
(631) 444-2348
NPI assigned
Jun 4, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD460958 PA
Urology Physician 208800000X MD460958 PA Primary

Addresses

Primary practice location

101 Nicolls Rd # Hsct9040
Stony Brook, NY 11794-8265

Mailing address

2350 Freedom Way Ste 102
York, PA 17402-8265
Phone (717) 741-9536

Other practice location 1

2350 Freedom Way Ste 102
York, PA 17402-8265
Phone (717) 741-9536

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Gauthami.Churukanti@direct.stonybrookmedicine.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210708000958 NY Practitioner - Urology 6406155548 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

24 Research Way
Suite 500
East Setauket, NY 11733-3470
Phone (631) 444-6270

P O Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection15

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Conemaugh Physician Practices LLC CurrentSince Apr 23, 2021 Accepting new patients
DLP Conemaugh Physician Practices LLC CurrentSince Apr 23, 2021 Accepting new patients
DLP Conemaugh Physician Practices LLC Current Accepting new patients
University Hospital at Stony Brook Current Accepting new patients
Stony Brook Urology, University Faculty Practice Corporation Urology CurrentSince Aug 1, 2021 Accepting new patients

Locations

4 Smith Haven Mall
Ste 110
Lake Grove, NY 11755

74 Commerce Ave
Riverhead, NY 11901
Phone (631) 727-3422

24 Research Way
Ste 500
Setauket, NY 11733
Phone (631) 444-2209

101 Nicolls Rd
#9040
Stony Brook, NY 11794
Phone (631) 444-2348

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1111 Franklin St
Ste 180
Johnstown, PA 15905
Phone (814) 534-3740

1111 Franklin St
Ste 410
Johnstown, PA 15905
Phone (814) 536-7851

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: gauthami.churukanti@direct.stonybrookmedicine.edu

Organizations & group practices 5

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 6

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": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1962763219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 FREEDOM WAY STE 102",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174028265",
            "telephone_number": "717-741-9536",
            "fax_number": "717-741-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD # HSCT9040",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948265",
            "telephone_number": "631-444-2348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 Freedom Way Ste 102",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174028265",
            "country_code": "US",
            "telephone_number": "717-741-9536",
            "fax_number": "717-741-5509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHURUKANTI",
        "first_name": "GAUTHAMI",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-04",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD460958",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD460958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Gauthami.Churukanti@direct.stonybrookmedicine.edu",
            "affiliation": "N",
            "address_1": "101 Nicolls Rd # Hsct9040",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117948265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.