Koyamangalath Krishnan, MD

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

30191 Issued in TN

Practice address

1 Professional Park Dr
Ste 21
Johnson City, TN 37604-6587

Phone

(423) 232-6900

Fax

(423) 232-6903

NPI assigned

Jul 21, 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 4

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  NPD
• Blue Ridge Medical Management Corporation

  dba TriCities Cancer Care

  • Medical Oncology Physician
  • Kingsport, TN
  • NPI 1538315452
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1144241464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PARK DR",
            "address_2": "STE 21",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046587",
            "telephone_number": "423-232-6900",
            "fax_number": "423-232-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PARK DR",
            "address_2": "STE 21",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046587",
            "telephone_number": "423-232-6900",
            "fax_number": "423-232-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAN",
        "first_name": "KOYAMANGALATH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "TN",
            "license": "30191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00867848",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144241464",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q020981",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3822354",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Koutsouvelis, MD
• Andrew A Kovacs, FNP-C
• Matthew B Kowalczyk
• Daniel E. Krenk, MD
• David Edward Kreshek, M.D.
• Karsyn Krob
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Daniel Robert Kubisiak, D.PH
• Kathleen Anne Kuczynski, DSW MSW

• Medical Oncology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Medical Oncology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.