Prem Thanaratnam, M.D.

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

22108 Issued in NV

Practice address

111 E 210TH St
Bronx, NY 10467-2401

Phone

(718) 696-2583

Fax

(718) 881-5074

NPI assigned

Apr 2, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Diagnostic Radiology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J Paul Wiesner and Associates CharteredGroup PAC ID 4880679976, 24 clinicians

Pueblo Medical Imaging LLCGroup PAC ID 2264328319, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Rose Dominican Hospitals - Siena Campus Hospital, Henderson, NV, CCN 290045
• Henderson Hospital Hospital, Henderson, NV, CCN 290057
• Saint Rose Dominican Hospitals - San Martin Campus Hospital, Las Vegas, NV, CCN 290053
• West Henderson Hospital Hospital, Henderson, NV, CCN 290062
• Mesa View Regional Hospital Hospital, Mesquite, NV, CCN 291307

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• J Paul Wiesner & Associates Chartered

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1487606026
  Medicare reassignment Care Compare group NPD
• Pueblo Medical Imaging, LLC

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1952353591
  Medicare reassignment Care Compare group NPD
• Radiology Specialists LTD Marasso-Miller

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1437196979

  Vascular & Interventional Radiology

  Medicare reassignment NPD

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

• Dignity Health

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1528101284
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1770626426
  Care Compare affiliation
• Henderson Hospital

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1003281452
  Care Compare affiliation
• Henderson Hospital

  • Emergency Care Clinic/Center
  • Henderson, NV
  • NPI 1285490292

  Hospital

  Care Compare affiliation
• Henderson Hospital

  • Emergency Care Clinic/Center
  • Henderson, NV
  • NPI 1376198028

  Hospital

  Care Compare affiliation
• MMC of Nevada LLC

  • Critical Access Hospital
  • Mesquite, NV
  • NPI 1275588782
  Care Compare affiliation
• West Henderson Hospital Medical Center LLC

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1962181172
  Care Compare affiliation

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1285029645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-696-2583",
            "fax_number": "718-881-5074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-696-2583",
            "fax_number": "718-881-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THANARATNAM",
        "first_name": "PREM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NV",
            "license": "22108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amogh Thalanki, DMD
• Jasmine Thalappillil, AGPCNP
• Allison Thaler
• Nancy Tham, MD, MBA
• Gloria Patricia Thambirajah, M.D.
• Pavinee Thanasawat, M.D.
• Shirish Thanawala
• Thresiamma George Thanjan, M.D.
• Anjali Thannikal
• Prava Thapa

• Vascular & Interventional Radiology Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Vascular & Interventional Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.