NPIMap

Individual provider Active NPI

Kozhaya Mallah, MD

  • Cardiovascular Disease Physician
  • Logan, WV
National Provider Identifier
1376717694
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
24018 Issued in WV
Practice address
20 Hospital Dr
Logan, WV 25601-3452
Phone
(304) 831-1602
Fax
(304) 831-1605
NPI assigned
Apr 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA08297600 NJ
Cardiovascular Disease Physician 207RC0000X 24018 WV Primary

Addresses

Primary practice location

20 Hospital Dr
Logan, WV 25601-3452

Mailing address

20 Hospital Dr
Logan, WV 25601-3452
Phone (304) 831-1602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20100701000225 WV Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 0244361467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Logan General Hospital LLCGroup PAC ID 9537078977, 27 clinicians

Practice addresses (Care Compare)

83 Hospital Dr
Logan, WV 25601-3451
Phone (304) 831-1602

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08297600NJMDInternal Medicine Physician
24018WVMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Appalachia Pathology Consultants LLC Current Accepting new patients

Locations

20 Hospital Dr
Logan, WV 25601
Phone (304) 792-1101

Interoperability endpoints

  • Direct secure messaging: kozhaya.mallah.1@26088.direct.athenahealth.com

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1376717694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HOSPITAL DR",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013452",
            "telephone_number": "304-831-1602",
            "fax_number": "304-831-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HOSPITAL DR",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013452",
            "telephone_number": "304-831-1602",
            "fax_number": "304-831-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAH",
        "first_name": "KOZHAYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-17",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08297600",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WV",
            "license": "24018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.