Individual provider Active NPI

Keerthika Mathialagan, MD

  • Student in an Organized Health Care Education/Training Program
  • Bradenton, FL
National Provider Identifier
1457096331
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
5325 E State Road 64 Ste B
Bradenton, FL 34208-5534
Phone
(941) 277-9922
NPI assigned
May 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME169251 FL
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

5325 E State Road 64 Ste B
Bradenton, FL 34208-5534

Mailing address

5325 E State Road 64 Ste B
Bradenton, FL 34208-5534
Phone (941) 277-9922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4310 Metro Pkwy
Fort Myers, FL 33916-7952

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME169251FLMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1457096331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 E STATE ROAD 64 STE B",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085534",
            "telephone_number": "941-277-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 E STATE ROAD 64 STE B",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085534",
            "telephone_number": "941-277-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIALAGAN",
        "first_name": "KEERTHIKA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-04",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME169251",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.