Mithun N Medagangoda, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

20A20946 Issued in CA

Practice address

4411 E Kings Canyon Rd # 319
Fresno, CA 93702-3604

Phone

(559) 600-2382

NPI assigned

Apr 5, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance for Wellness IncGroup PAC ID 9931355617, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Co of Mary Med Ctr San Pedro Hospital, San Pedro, CA, CCN 050078

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Alliance for Wellness, Inc.

  • Psychiatry Physician
  • Inglewood, CA
  • NPI 1124329131
  Medicare reassignment Care Compare group NPD
• Health Alliance Socal, Inc

  • Psychiatry Physician
  • Inglewood, CA
  • NPI 1184343055
  Medicare reassignment
• Precision Psychiatric Services Inc

  • Neurology Physician
  • San Jose, CA
  • NPI 1174094064
  Medicare reassignment
• Psychplus Associates of California PC

  • Psychiatry Physician
  • Berkeley, CA
  • NPI 1457179442
  Medicare reassignment
• Psychplus Medical Associates of California PC

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1124875588

  CA

  Medicare reassignment
• Tamika Henry MD Inc

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1770381436
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1497241541
  Care Compare affiliation
• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1942247291
  Care Compare affiliation

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

{
    "created_epoch": "1586044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1033748702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 E KINGS CANYON RD # 319",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937023604",
            "telephone_number": "559-600-2382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 W Mineral King Ave",
            "address_purpose": "LOCATION",
            "city": "Visalia",
            "state": "CA",
            "postal_code": "932916237",
            "country_code": "US",
            "telephone_number": "714-318-2186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDAGANGODA",
        "first_name": "MITHUN",
        "middle_name": "N",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-05",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A20946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Marie Meadows, RADT
• Riley Morgan Means
• John R Meccico, PA-C
• Steven Gale Mecham, AU.D.
• Aidan Mechem
• Medamerica
• Medcare Health, Inc.
• Medeiros MD PC
• Kari Anne Medeiros, AMFT
• Rosario Medel

• Psychiatry Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.