NPIMap

Individual provider Active NPI

Kishore K. Kalluri, M.D.

  • Nephrology Physician
  • Modesto, CA
National Provider Identifier
1073517751
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
C53094 Issued in CA
Practice address
600 Coffee Rd
Modesto, CA 95355-4201
Phone
(209) 524-1211
NPI assigned
Jun 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036103114 IL
Nephrology Physician 207RN0300X C53094 CA Primary

Addresses

Primary practice location

600 Coffee Rd
Modesto, CA 95355-4201

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

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
I20081216000355 CA Practitioner - Nephrology 3476574732 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical Foundation 2,473 clinicians

Practice addresses (Care Compare)

1700 Coffee Rd
Modesto, CA 95355-2803
Phone (209) 526-4500

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

Hospital & facility affiliations

  • SCH Modesto Coffee Dialysis facility, Modesto, CA, CCN 052531
  • SHC Central Modesto Dialysis facility, Modesto, CA, CCN 552536
  • SHC Ceres Dialysis facility, Modesto, CA, CCN 552803
  • DaVita Pacheco Dialysis Dialysis facility, Los Banos, CA, CCN 552804
  • SHC WB Modesto Dialysis facility, Modesto, CA, CCN 552524
  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • Sutter Tracy Community Hospital Hospital, Tracy, CA, CCN 050313
  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335
  • Doctors Medical Center Hospital, Modesto, CA, CCN 050464
  • Memorial Hospital Los Banos Hospital, Los Banos, CA, CCN 050528

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C53094CAMDNephrology Physician
036103114ILMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital CurrentSince Feb 16, 2015 Accepting new patients
Sonora Community Hospital CurrentSince Feb 16, 2015 Accepting new patients
Sonora Community Hospital Current Accepting new patients
Hammmond Henry Retail Pharmacy Past Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients
Trinity Medical Center Past Accepting new patients
Genesis Health System Past Accepting new patients
Blessingcare Corporation Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Genesis Health System Past Accepting new patients
Satellite Healthcare Jamestown, LLC PastSince Jul 28, 2023 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

193 Fairview Ln
Sonora, CA 95370
Phone (209) 536-5100

Interoperability endpoints

  • Direct secure messaging: kkishore34839@hisp.ehr.sutterhealth.org

Organizations & group practices 37

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.

View all 37

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1073517751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLURI",
        "first_name": "KISHORE",
        "middle_name": "K.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036103114",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "C53094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.