Active NPI
Mohan Krishna Bangaru
- Nephrology Physician
- Detroit, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 4301119098
- Practice address
- 4201 Saint Antoine St
Detroit, MI 48201-2153 - Phone
- (313) 745-7145
- NPI assigned
- Aug 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 4301119098 | MI | Primary |
Addresses
Primary practice location
4201 Saint Antoine St
Detroit, MI 48201-2153
Mailing address
19426 Mayfield Ave Apt 104
Livonia, MI 48152-4203
Phone (313) 421-6686
Other practice location 1
37595 7 Mile Rd
suite 340
Livonia, MI 48152-1003
Phone (734) 793-2470
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B526609478425 | Other | MI | DRIVING LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2149 E Warner Rd
Suite 101
Tempe, AZ 85284-3495
Phone (480) 610-6100
2946 E Banner Gateway Dr
Gilbert, AZ 85234-2165
Phone (480) 256-6444
Hospital & facility affiliations
- 032597 San Carlos Dialysis (FMC)
- Banner Gateway Medical Center
- Honorhealth Four Peaks Medical Center
- Banner Baywood Medical Center
- Banner Ironwood Medical Center
- Dignity Health Arizona General Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Kidney Specialists LLC | Single Specialty | Current | Accepting new patients |
| Banner Cancer Center Specialists LLC | Single Specialty | Current | Accepting new patients |
| Banner Cancer Center Specialists LLC | Single Specialty | Current | Accepting new patients |
| Southwest Kidney Institute, PLC | Single Specialty | Current | Accepting new patients |
| Southwest Kidney Institute, PLC | Single Specialty | Current | Accepting new patients |
Locations
2946 E Banner Gateway Dr
Rm 2008
Gilbert, AZ 85234
Phone (480) 256-4523
2946 E Banner Gateway Dr
Gilbert, AZ 85234
Phone (480) 256-5450
301 S Power Rd
Mesa, AZ 85206
9305 W Thomas Rd
Ste 255
Phoenix, AZ 85037
Phone (623) 247-9235
2149 E Warner Rd
Ste 101
Tempe, AZ 85284
Phone (480) 610-6111
2149 E Warner Rd
Tempe, AZ 85284
2149 E Warner Rd
Ste 102
Tempe, AZ 85284
Phone (623) 247-0808
130 Medical Way
Ste D
Stockbridge, GA 30281
Phone (470) 419-4000
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GHHGAD
- mohan.krishna.bangaru.1@2697.direct.athenahealth.com
Organizations & group practices 5
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.
-
- Oncology Clinic/Center
- Phoenix, AZ
- NPI 1518253152
Single Specialty
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Stockbridge, GA
- NPI 1558814459
Single Specialty
-
- Oncology Clinic/Center
- Payson, AZ
- NPI 1588158448
Single Specialty
-
- Nephrology Physician
- Sierra Vista, AZ
- NPI 1891933560
Single Specialty
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Peridot, AZ
- NPI 1487756656
Dialysis facility
-
- General Acute Care Hospital
- Mesa, AZ
- NPI 1689121188
-
- General Acute Care Hospital
- Mesa, AZ
- NPI 1194758284
-
- General Acute Care Hospital
- Gilbert, AZ
- NPI 1699884858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1275932121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19426 MAYFIELD AVE APT 104",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481524203",
"telephone_number": "313-421-6686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-745-7145"
}
],
"practiceLocations": [
{
"address_1": "37595 7 Mile Rd",
"address_2": "suite 340",
"address_purpose": "LOCATION",
"city": "Livonia",
"state": "MI",
"postal_code": "481521003",
"country_code": "US",
"telephone_number": "734-793-2470",
"fax_number": "734-793-2471",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BANGARU",
"first_name": "MOHAN KRISHNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-16",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "MI",
"license": "4301119098",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVING LICENSE",
"identifier": "B526609478425",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
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.
- 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.