Individual provider Active NPI

Manmohan Pothuloori, MD

  • Psychiatry Physician
  • Prestonsburg, KY
National Provider Identifier
1225020332
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
43327 Issued in KY
Practice address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone
(606) 886-8572
Fax
(606) 886-4433
NPI assigned
Aug 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 43327 KY Primary

Addresses

Primary practice location

104 S Front Ave
Prestonsburg, KY 41653-1614

Mailing address

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20100526000395 KY Practitioner - Psychiatry 9436143245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-4346

118 River Dr
Pikeville, KY 41501-1597
Phone (606) 433-2303

123 S Main St
Winchester, KY 40391-2621
Phone (606) 886-8572

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18791NEMDInfectious Disease Physician
43327KYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Comprehensive Care Center, Inc. Current Accepting new patients
Mountain Comprehensive Care Center, Inc. CurrentSince Jun 1, 2016 Accepting new patients
Mountain Comprehensive Care Center, Inc. CurrentSince Jun 1, 2016 Accepting new patients
Family Psychiatric Associates of Lincoln P.C. Psychiatry Past Accepting new patients

Locations

1110 S Mayo Trl
Paintsville, KY 41240
Phone (606) 788-1345

838 S Mayo Trl
Paintsville, KY 41240
Phone (606) 788-1345

118 River Dr
Pikeville, KY 41501
Phone (606) 432-3143

118 S Front Ave
Prestonsburg, KY 41653

104 S Front Ave
Prestonsburg, KY 41653
Phone (606) 688-6857

26229 US Highway 119 N
Toler, KY 41514
Phone (606) 237-0020

Interoperability endpoints

  • Direct secure messaging: manmohan.pothuloori.p1@direct.mtcomp.nextgenshare.com

Organizations & group practices 4

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1225020332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHULOORI",
        "first_name": "MANMOHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "43327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.