NPIMap

Individual provider Active NPI

Soma Krishnamoorthi, M.D.

  • Internal Medicine Physician
  • Escalon, CA
National Provider Identifier
1013011055
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A76562 Issued in CA
Practice address
850 W California Street
Escalon, CA 95320-1506
Phone
(209) 838-2278
Fax
(209) 525-3124
NPI assigned
Sep 11, 2006
Last updated
May 3, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 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 A76562 CA Primary

Addresses

Primary practice location

850 W California Street
Escalon, CA 95320-1506

Mailing address

850 W California Street
Escalon, CA 95320-1506
Phone (209) 838-2278

Other identifiers 1

IdentifierTypeStateIssuer
RHM53830HMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20070330000506 CA Practitioner - Internal Medicine 9335141514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2222 E Orangeburg Ave
Suite A2
Modesto, CA 95355-3399
Phone (209) 622-0877

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
99.06
Improvement activities
40
Cost
96.39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A76562CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Krishnamoorthi MD Inc a Professional Medical Corporation Current Accepting new patients
Brian J Cormier Physician Assistant Inc Current Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

850 California St
Escalon, CA 95320
Phone (209) 838-2278

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Krishnamoorthi MD Inc a Professional Medical CorporationEscalon, CA, CCN 553830 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Director (50%)
W-2 Managing Employee (50%)		 Apr 1, 2007
Apr 1, 2007
Apr 1, 2007
Krishnamoorthi MD Inc a Professional Medical CorporationWaterford, CA, CCN 553829 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Director
W-2 Managing Employee		 Apr 1, 2007
Apr 1, 2007
Apr 1, 2007

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 5

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1013011055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W CALIFORNIA STREET",
            "city": "ESCALON",
            "state": "CA",
            "postal_code": "953201506",
            "telephone_number": "209-838-2278",
            "fax_number": "209-525-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W CALIFORNIA STREET",
            "city": "ESCALON",
            "state": "CA",
            "postal_code": "953201506",
            "telephone_number": "209-838-2278",
            "fax_number": "209-525-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAMOORTHI",
        "first_name": "SOMA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A76562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53830H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Escalon, CA

Sources for this page

Verify at the official NPI Registry.