Prabodh Mishra

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

65950 Issued in TN

Practice address

647 Dulop Suite 200
Clarksville, TN 37040

Phone

(931) 648-0064

Fax

(931) 553-4215

NPI assigned

Jun 27, 2016

Last updated

Dec 14, 2022By the provider in NPPES

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

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

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Saint Thomas Medical PartnersGroup PAC ID 1557269354, 588 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vanderbilt Clarksville Hospital Hospital, Clarksville, TN, CCN 440035
• Ascension Saint Thomas Hospital Hospital, Nashville, TN, CCN 440082
• Vanderbilt University Medical Center Hospital, Nashville, TN, CCN 440039
• Tristar Northcrest Medical Center Hospital, Springfield, TN, CCN 440065

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: prabodh.mishra.1@7654.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saint Thomas Medical Partners

  dba Ascension Medical Group Saint Thomas

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1437194669
  Medicare reassignment Care Compare group NPD

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

• Clarksville Health System, LLC

  dba Tennova Healthcare-Clarksville

  • General Acute Care Hospital
  • Clarksville, TN
  • NPI 1285689794
  Care Compare affiliation
• Saint Thomas West Hospital

  dba Ascension Saint Thomas Hospital

  • General Acute Care Hospital
  • Nashville, TN
  • NPI 1629025648
  Care Compare affiliation
• Springfield Health Services, LLC

  dba NorthCrest Medical Center

  • General Acute Care Hospital
  • Springfield, TN
  • NPI 1093397184
  Care Compare affiliation
• Vanderbilt University Medical Center

  • General Acute Care Hospital
  • Nashville, TN
  • NPI 1396882205
  Care Compare affiliation

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1245681659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 20TH AVE N STE 403",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372035180",
            "telephone_number": "931-648-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 DULOP SUITE 200",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37040",
            "telephone_number": "931-648-0064",
            "fax_number": "931-553-4215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Ashley Avenue",
            "address_2": "Room 202 Main Hospital, MSC 333",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "29425",
            "country_code": "US",
            "telephone_number": "843-792-2911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "PRABODH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL39709",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "65950",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "65950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miniar LLC
• Deandra Minor
• Elvira Minor
• Shannon Marie Miracle, CNA
• Blake C. Mishler, PHARMD
• Pradip K Mishra, M.D.
• Kelsie Lynn Miskowiec
• Ashlee Mitchell
• Bayleigh Mitchell
• Erik A Mitchell, DPT

• Cardiovascular Disease Physician in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Cardiovascular Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.