NPIMap

Organization Active NPI

Krishnamoorthi MD Inc a Professional Medical Corporation

  • Rural Health Clinic/Center
  • Waterford, CA
National Provider Identifier
1316098205
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION
Practice address
324 F St
Waterford, CA 95386-9013
Phone
(209) 874-2321
Fax
(209) 874-3896
NPI assigned
Jan 16, 2007
Last updated
Feb 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Authorized official

Name
Dr. Krishnamoorthi KrishnamoorthiNPI 1588762538
Title
Doctor
Phone
(209) 874-2321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

324 F St
Waterford, CA 95386-9013

Mailing address

324 F St
Waterford, CA 95386-9013
Phone (209) 609-6629

Other identifiers 2

IdentifierTypeStateIssuer
RHM53829HMedicaidCA
00A708970MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krishnamoorthi-krishnamoorthi@krishnamoorthimdinc.e-mdsdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070201000488 CA Part A Provider - Rural Health Clinic 1153323324 Practice locations: Waterford, CA
O20070330000427 CA Part B Supplier - Clinic/Group Practice 1153323324 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Escalon, CA; Modesto, CA; Waterford, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316098205. Details of each certification follow.

Rural health clinic certification: CCN 553829

Legal name
KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 18, 1994
Last certification
Aug 31, 2017
Ownership / control type
1B
Most recent change of ownership
Apr 1, 2007 (2 total)
Organization structure
CorporationProprietary
Incorporated
Sep 20, 2006 in CA
Enrollment address
324 F St
Waterford, CA 95386-9013

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0611209Krishnamoorthi, MD Inc324 F Street, Waterford, CA 95386Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Krishnamoorthi MD Inc Apmc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

324 F St
Waterford, CA 95386
Phone (209) 874-1292

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: krishnamoorthi-krishnamoorthi@krishnamoorthimdinc.e-mdsdirect.com

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Krishnamoorthi Krishnamoorthi Individual 5% Or Greater Direct Ownership Interest Apr 1, 2007
Corporate Director Apr 1, 2007
W-2 Managing Employee Apr 1, 2007
Soma Krishnamoorthi Individual 5% Or Greater Direct Ownership Interest Apr 1, 2007
Corporate Director Apr 1, 2007
W-2 Managing Employee Apr 1, 2007

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Krishnamoorthi MD Inc a Professional Medical CorporationEscalon, CA, CCN 553830 Rural health clinic 5% Or Greater Direct Ownership Interest Apr 1, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1316098205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 F ST",
            "city": "WATERFORD",
            "state": "CA",
            "postal_code": "953869013",
            "telephone_number": "209-609-6629",
            "fax_number": "209-874-3896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 F ST",
            "city": "WATERFORD",
            "state": "CA",
            "postal_code": "953869013",
            "telephone_number": "209-874-2321",
            "fax_number": "209-874-3896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISHNAMOORTHI MD INC A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "KRISHNAMOORTHI",
        "authorized_official_first_name": "KRISHNAMOORTHI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "209-874-2321",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53829H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A708970",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krishnamoorthi-krishnamoorthi@krishnamoorthimdinc.e-mdsdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "324 F St",
            "city": "Waterford",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953869013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waterford, CA

Sources for this page

Verify at the official NPI Registry.