Krishnamoorthi MD Inc a Professional Medical Corporation
Organization Active NPI Rural Health Clinic/Center · Escalon, CA
NPI 1285785154 · NPPES record last updated Jan 2, 2026
Key facts
- NPI
- 1285785154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION
- Practice address
- 850 California St
Escalon, CA 95320-1506 - Phone
- (209) 838-2278
- NPI assigned
- Jan 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Soma Krishnamoorthi, M.D.
- Title
- Cfo
- Phone
- (209) 838-2278
Owners & managing parties with NPI records 3
-
Soma Krishnamoorthi, M.D.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 6
-
Soma Krishnamoorthi, M.D.
-
Marla Dianne Steckwren, M.S.W.
-
Wamaitha Whidby, LCSW
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0609869 | Krishnamoorthi, MD Inc | Certificate of waiver | Mar 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Rural health clinic certification: CCN 553830
- Legal name
- KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 15, 1994
- Last certification
- Mar 5, 2014
- Ownership / control type
- 1A
- Most recent change of ownership
- Apr 1, 2007 (2 total)
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 20, 2006 in CA
- Enrollment address
- 850 W California Street
Escalon, CA 95320-1506
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Krishnamoorthi MD Inc a Professional Medical Corporation |
5% Or Greater Direct Ownership Interest | Apr 1, 2007 | |
| Krishnamoorthi Krishnamoorthi |
5% Or Greater Direct Ownership Interest | Apr 1, 2007 | 50% |
| Corporate Director |
Apr 1, 2007 | 50% | |
| W-2 Managing Employee |
Apr 1, 2007 | 50% | |
| Soma Krishnamoorthi |
5% Or Greater Direct Ownership Interest | Apr 1, 2007 | 50% |
| Corporate Director |
Apr 1, 2007 | 50% | |
| W-2 Managing Employee |
Apr 1, 2007 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070201000342 | CA | Part a Provider - Rural Health Clinic | 1153323324 | Practice locations: Escalon, CA |
| O20070330000427 | CA | Part B Supplier - Clinic/Group Practice | 1153323324 |
Receives reassigned benefits from 4 practitioners 2 other NPIs on this enrollment Practice locations: Escalon, CA; Modesto, CA; Waterford, CA |
National Provider Directory
Locations
850 California St
Escalon, CA 95320
Phone (209) 838-2278
Interoperability endpoints
- soma-krishnamoorthi@krishnamoorthimdinc.e-mdsdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
850 California St
Escalon, CA 95320-1506
Mailing address
850 California St
Escalon, CA 95320-1506
Phone (209) 838-2278
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RHM53830H | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | soma-krishnamoorthi@krishnamoorthimdinc.e-mdsdirect.com | Health Information Exchange (HIE) |
Other providers in Escalon, CA
- Reina Hammond
- HRH Pharmacy Inc
- Gustavo Jimenez-Fregoso
- James Key
- Laurena Carole Krieger
- Soma Krishnamoorthi
- L.Edward Elliott, O.D.
- Marissa Lee
- Mayra Alejandra Manzo
- Marshall Dental Group, Inc. a Professional Dental Corporation
All providers in Escalon, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.