KAUSTUBH KAILASH SHRIVASTAVA (M.D) – Internal Medicine Physician, NPI 1396021770

KAUSTUBH KAILASH SHRIVASTAVA (M.D) is a healthcare provider. based in Bar harbor, Maine. specializing in INTERNAL MEDICINE. They hold the professional credentials M.D. They hold a License No. MD19979 (ME). The NPI Number for KAUSTUBH KAILASH SHRIVASTAVA (M.D) is 1396021770

Main info

Male
Sole Proprietor
23 Years Of Experience
Accepts Medicare Assignment
Name
KAUSTUBH KAILASH SHRIVASTAVA (M.D)
NPI
1396021770
Phone
(567) 210-0190
Address
61 LEDGELAWN AVE
Enumeration Date
28 October 2011
Last Update Date
21 July 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9372088000
Graduation Year
2003 (23 years ago)
PAC ID
5496975674
Group Practice PAC ID
9830536911
Professional Enrollment ID
I20171215001196
Address ID
OH454092722DA1XXXXSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:14State licenses:2Digital endpointsOther names

7,201 INTERNAL MEDICINE in OH

Provider Addresses for KAUSTUBH KAILASH SHRIVASTAVA (M.D)

  • 61 LEDGELAWN AVE

    BAR HARBOR, ME 046091303

    Phone: (567) 210-0190

    Type: Mailing

  • 30 E APPLE ST STE NW3300

    DAYTON, OH 454092939

    Phone: (937) 208-8394

    Fax: (937) 208-8388

    Type: Location

  • 10 Wayman Ln

    Bar Harbor, ME 046091625

    Phone: (207) 288-5081

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-12-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20171215001196IInternal MedicineOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes27794$0
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes21189$0
99239Hospital discharge day management, more than 30 minutes8181$0
99223Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes3131$0
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes2020$0
View full utilization report →

Insurance plans in this area (ZIP 04609)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9830536911View full group profile
NameSpecialtyState
Family PracticePA
Nurse PractitionerIN
Physician AssistantOH
Nurse PractitionerOH
Internal MedicineOH
Internal MedicineOH
Nurse PractitionerOH
Hospitalist, Internal MedicineOH
Internal MedicineOH
Physician AssistantOH

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Frequently asked questions

How is KAUSTUBH KAILASH SHRIVASTAVA (M.D) identified in CMS data?
CMS-hosted NPPES data lists KAUSTUBH KAILASH SHRIVASTAVA (M.D) with NPI 1396021770.
Is KAUSTUBH KAILASH SHRIVASTAVA (M.D) listed as active for patients and plans?
The listing shows KAUSTUBH KAILASH SHRIVASTAVA (M.D) as active in the NPI system.
What healthcare role does KAUSTUBH KAILASH SHRIVASTAVA (M.D) hold?
Scheduling teams often label KAUSTUBH KAILASH SHRIVASTAVA (M.D) under Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is KAUSTUBH KAILASH SHRIVASTAVA (M.D) based?
KAUSTUBH KAILASH SHRIVASTAVA (M.D) is tied to Bar Harbor, Maine in the data we show; additional addresses may exist on the full record.
Why does KAUSTUBH KAILASH SHRIVASTAVA (M.D) have multiple addresses?
3 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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