NPIMap

Individual provider Active NPI

Malathi Tadakamalla, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Lee's Summit, MO
National Provider Identifier
1316989197
Registry record updated May 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
2009003023 Issued in MO
Practice address
600 NE Meadowview Dr
Lees Summit, MO 64064-1983
Phone
(913) 226-7332
Fax
(913) 674-5563
NPI assigned
Jun 13, 2006
Last updated
May 14, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 2009003023 MO Primary

Addresses

Primary practice location

600 NE Meadowview Dr
Lees Summit, MO 64064-1983

Mailing address

PO Box 219209
Kansas City, MO 64121-9209
Phone (913) 226-7332

Other identifiers 1

IdentifierTypeStateIssuer
MA3153001,OtherMOMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091008000387 MO Practitioner - Geriatric Medicine 4880730688 Reassigns benefits to 1 organization
I20100923000629 KS Practitioner - Geriatric Medicine 4880730688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability KCGroup PAC ID 0143116368, 166 clinicians
Complete Health Care Services PAGroup PAC ID 7012199326, 9 clinicians

Practice addresses (Care Compare)

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

8900 Parallel Pkwy
Kansas City, KS 66112-1637
Phone (913) 788-2100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009003023MOMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sunterra Independence Oc, LLC Past Accepting new patients
Geriatric Healthcare Services, LLC Past Accepting new patients
Shangri la Hco, LLC Past Accepting new patients
Independence Manor Inc Past Accepting new patients
Geriatric Health Services, Inc. Geriatric Medicine Past Accepting new patients
Monterey Park Nursing Center, Inc Past Accepting new patients
Independence 1 Inc PastSince Feb 26, 2021 Accepting new patients
Wilshire Operator LLC Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Maywood Terrace Living CenterIndependence, MO, CCN 265404 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 26, 2021
Feb 26, 2021
Sunterra Springs IndependenceIndependence, MO, CCN 265864 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2017
Nov 1, 2017

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431561600000",
    "number": "1316989197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219209",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641219209",
            "telephone_number": "913-226-7332",
            "fax_number": "913-674-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NE MEADOWVIEW DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641983",
            "telephone_number": "913-226-7332",
            "fax_number": "913-674-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADAKAMALLA",
        "first_name": "MALATHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2015-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2009003023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA3153001,",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

Verify at the official NPI Registry.