Active NPI
Rathna Sree Mallela, M.D., M.P.H.
- Child & Adolescent Psychiatry Physician
- Janesville, WI
National Provider Identifier
1194043554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 64316-20
- Practice address
- 2600 Humes Rd Ste 100
Janesville, WI 53545-0491 - Phone
- (608) 741-2117
- Fax
- (608) 758-5761
- NPI assigned
- May 11, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Child & Adolescent Psychiatry Physician | 2084P0804X | 64316-20 | WI | Primary |
Addresses
Primary practice location
2600 Humes Rd Ste 100
Janesville, WI 53545-0491
Mailing address
2600 Humes Rd Ste 100
Janesville, WI 53545-0491
Phone (608) 741-2117
Other practice location 1
20 E Court St
Janesville, WI 53545-3919
Phone (608) 755-8923
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K400258434-00084908 | Other | WI | WI MEDICARE |
| 1194043554 | Other | WI | BCBSWI |
| 1194043554 | Other | WI | DEANHEALTH PLAN |
| 1194043554 | Medicaid | WI | |
| K400258432-000054176 | Other | WI | WI MEDICARE |
| MALLERAT | Other | WI | MERCYCARE INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64316-20 | WI | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1194043554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 HUMES RD STE 100",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450491",
"telephone_number": "608-741-2117",
"fax_number": "608-758-5761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 HUMES RD STE 100",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450491",
"telephone_number": "608-741-2117",
"fax_number": "608-758-5761"
}
],
"practiceLocations": [
{
"address_1": "20 E Court St",
"address_purpose": "LOCATION",
"city": "Janesville",
"state": "WI",
"postal_code": "535453919",
"country_code": "US",
"telephone_number": "608-755-8923",
"fax_number": "608-758-5761",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MALLELA",
"first_name": "RATHNA",
"middle_name": "SREE",
"credential": "M.D., M.P.H.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-11",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "WI",
"license": "64316-20",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI MEDICARE",
"identifier": "K400258434-00084908",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSWI",
"identifier": "1194043554",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEANHEALTH PLAN",
"identifier": "1194043554",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1194043554",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI MEDICARE",
"identifier": "K400258432-000054176",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE INSURANCE",
"identifier": "MALLERAT",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.