Krishna Mohan Jain, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

4301043579 Issued in MI

Practice address

1815 Henson Ave
Kalamazoo, MI 49048-1510

Phone

(269) 492-6500

Fax

(269) 492-6461

NPI assigned

Apr 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• National Surgical Centers Stockton, LLC

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
  • NPI 1922625995
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302566400000",
    "number": "1013972769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 HENSON AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481510",
            "telephone_number": "269-492-6500",
            "fax_number": "269-492-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 HENSON AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481510",
            "telephone_number": "269-492-6500",
            "fax_number": "269-492-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "KRISHNA",
        "middle_name": "MOHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2011-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301043579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341660510",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013972769",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4309785",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "3733063",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BMH",
            "identifier": "1417961137",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK PROVIDE",
            "identifier": "P53787",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lara Megan Jacobs, LLPC
• Linnea Jaconette, CRNA
• Ayaz Jaffer, RPH
• Jasmine Jaggers
• Jai Chamunda Kalamazoo, Inc.
• Mohammed Jamaluddin
• James L. Souers, D.D.S., Orthodontist, P.C.
• Alana James, LLMSW
• Barbara Jean James
• Bri James

• Vascular Surgery Physician in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.