Individual provider Active NPI

Raja Mohan, M.D.

  • Plastic Surgery Physician
  • Dallas, TX
National Provider Identifier
1043534589
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
Q8960 Issued in TX
Practice address
7777 Forest LN Ste C820
Dallas, TX 75230-2552
Phone
(469) 301-1725
Fax
(469) 301-1769
NPI assigned
Mar 25, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X UNLICENSED MD
Plastic Surgery Physician 208200000X Q8960 TX Primary

Addresses

Primary practice location

7777 Forest LN Ste C820
Dallas, TX 75230-2552

Mailing address

7777 Forest LN Ste C820
Dallas, TX 75230-2552
Phone (469) 301-1725

Other practice location 1

909 Ese 323 Loop Ste 777
Tyler, TX 75701
Phone (903) 606-8888

Other identifiers 1

IdentifierTypeStateIssuer
Q8960OtherTXTMB FULL MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20181015001151 TX Practitioner - Plastic and Reconstructive Surgery 7315196904 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
UNLICENSEDMDMDHematology & Oncology Physician
Q8960TXMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 15, 2025 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 15, 2025 Accepting new patients
Halani Plastic Surgery, PA Plastic Surgery PastSince Mar 30, 2025 Accepting new patients

Locations

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

909 Ese 323 Loop
Ste 777
Tyler, TX 75701
Phone (903) 606-8888

Interoperability endpoints

  • Direct secure messaging: rmohan617202@christushealth.direct-ci.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1043534589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE C820",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302552",
            "telephone_number": "469-301-1725",
            "fax_number": "469-301-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE C820",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302552",
            "telephone_number": "469-301-1725",
            "fax_number": "469-301-1769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "909 ESE 323 LOOP STE 777",
            "address_purpose": "LOCATION",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "country_code": "US",
            "telephone_number": "903-606-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "RAJA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-25",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MD",
            "license": "UNLICENSED",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "Q8960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TMB FULL MEDICAL LICENSE",
            "identifier": "Q8960",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.