NPIMap

Individual provider Active NPI

Mohan C Madala, MD

  • Cardiovascular Disease Physician
  • Okemos, MI
National Provider Identifier
1295949030
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
4301077662 Issued in MI
Practice address
2134 Hampton PL
Okemos, MI 48864-3691
Phone
(517) 347-3000
Fax
(517) 347-8393
NPI assigned
May 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301077662 MI Primary

Addresses

Primary practice location

2134 Hampton PL
Okemos, MI 48864-3691

Mailing address

2134 Hampton PL
Okemos, MI 48864-3691
Phone (517) 347-3000

Other identifiers 1

IdentifierTypeStateIssuer
1295949030MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041013000232 MI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1254391493 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Michigan State University College of Human Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Medical GroupGroup PAC ID 3971416082, 240 clinicians
McLaren Greater LansingGroup PAC ID 7214833466, 96 clinicians

Practice addresses (Care Compare)

1500 S Main St
Eaton Rapids, MI 48827-1952
Phone (517) 633-9403

2134 Hampton PL
Okemos, MI 48864-3691
Phone (517) 347-3000

Hospital & facility affiliations

  • McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167
  • Eaton Rapids Medical Center Hospital, Eaton Rapids, MI, CCN 231324
  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301077662MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Medical Group CurrentSince Jan 30, 2023 Accepting new patients
McLaren Greater Lansing Cardiovascular Disease CurrentSince Dec 6, 2010 Accepting new patients
McLaren Medical Group CurrentSince Jan 30, 2023 Accepting new patients
McLaren Greater Lansing CurrentSince Dec 6, 2010 Accepting new patients
McLaren Greater Lansing Current Accepting new patients
Mid-Michigan Physicians, PC Cardiovascular Disease Past Accepting new patients
McLaren Greater Lansing Past Accepting new patients

Locations

39373 Garfield Rd
Clinton Twp, MI 48038
Phone (586) 286-4880

1500 S Main St
Eaton Rapids, MI 48827
Phone (517) 663-2671

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

3520 Forest Rd
Ste 200
Lansing, MI 48910

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

405 W Greenlawn Ave
Ste 305
Lansing, MI 48910
Phone (517) 483-4780

3737 Lansing Rd
#H
Perry, MI 48872
Phone (517) 347-3000

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1295949030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2134 HAMPTON PL",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643691",
            "telephone_number": "517-347-3000",
            "fax_number": "517-347-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2134 HAMPTON PL",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643691",
            "telephone_number": "517-347-3000",
            "fax_number": "517-347-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADALA",
        "first_name": "MOHAN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301077662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295949030",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Okemos, MI

Sources for this page

Verify at the official NPI Registry.