Maneesh Mohan, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

8191 Issued in KY

Practice address

5100 Outer Loop
Suite B
Louisville, KY 40219-3201

Phone

(502) 966-8660

Fax

(502) 969-8444

NPI assigned

Oct 14, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

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.

• Oral Surgery Group of Frankfort, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Frankfort, KY
  • NPI 1568768224
  Medicare reassignment NPD
• Oral Surgery Group of Middletown, PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Middletown, KY
  • NPI 1497070148
  Medicare reassignment NPD
• Oral Surgery Group of Southern Indiana, LLC

  • Dental Clinic/Center
  • New Albany, IN
  • NPI 1831377712

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402531200000",
    "number": "1154310985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2441 STATE ST",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471504962",
            "telephone_number": "812-944-7200",
            "fax_number": "812-945-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 OUTER LOOP",
            "address_2": "SUITE B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193201",
            "telephone_number": "502-966-8660",
            "fax_number": "502-969-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "MANEESH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2014-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "8191",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12011030A",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "8181",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200872180",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "9179239",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6411381400",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204E0000X",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50007575",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayoub Mogassbi, M.D.
• Mustafa Mohamed
• Mohammad a. Mian, MD PSC
• Sura Mohammad
• Vahid Mohammadzadeh, MD
• Ranjini Mohan, PH.D
• Mohana R Arla MD PSC
• Leena Mohapatra, MS
• Olivia Adams Moharer, MD, MSB
• Khairunissa Batool Mohiuddin, NP

• Oral and Maxillofacial Surgery (Dentist) in Louisville, KY
• Providers in Louisville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.