NPIMap

Individual provider Active NPI

Bobby Koshy Muthalaly, MD

  • Nephrology Physician
  • Tulsa, OK
National Provider Identifier
1457375586
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
20881 Issued in OK
Practice address
2000 S Wheeling Ave
Ste. 510
Tulsa, OK 74104-5649
Phone
(918) 747-5200
Fax
(918) 748-7517
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 20881 OK Primary

Addresses

Primary practice location

2000 S Wheeling Ave
Ste. 510
Tulsa, OK 74104-5649

Mailing address

2000 S Wheeling Ave
Ste. 510
Tulsa, OK 74104-5649
Phone (918) 747-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 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
I20101004001201 OK Practitioner - NephrologyPractitioner - Internal Medicine 5991997314 Reassigns benefits to 2 organizations
I20240718003014 TX Practitioner - Nephrology 5991997314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Associates, Inc.Group PAC ID 9234020629, 21 clinicians

Practice addresses (Care Compare)

2000 S Wheeling Ave
Suite 510
Tulsa, OK 74104-5642
Phone (918) 747-5200

Hospital & facility affiliations

  • Fmcna - Jane Phillips Dialysis facility, Bartlesville, OK, CCN 372597
  • Fmcna - North Harvard Dialysis facility, Tulsa, OK, CCN 372594
  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018
  • Cherokee Nation W W Hastings Indian Hospital Hospital, Tahlequah, OK, CCN 370171
  • Saint Francis Hospital Muskogee Hospital, Muskogee, OK, CCN 370025
  • Coffeyville Regional Medical Center, Inc Hospital, Coffeyville, KS, CCN 171387

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates, Inc. Nephrology CurrentSince Dec 1, 2001 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jul 8, 2024 Accepting new patients
Creek Nation Hospital & Clinics Current Accepting new patients
Creek Nation Hospital & Clinics Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jul 8, 2024 Accepting new patients
Physicians Choice Dialysis of Bristow LLC PastSince Dec 8, 2011 Accepting new patients
Fresenius Medical Care Tulsa, LLC PastSince Feb 18, 2016 Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

3500 State St
Bartlesville, OK 74006
Phone (918) 224-9620

1101 S Belmont Ave
Ste 204
Okmulgee, OK 74447
Phone (918) 756-3526

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

Dept 515
Tulsa, OK 74182

2000 S Wheeling Ave
Ste 510
Tulsa, OK 74104
Phone (918) 747-5200

Dept 1467
Tulsa, OK 74182

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Interoperability endpoints

  • Direct secure messaging: bmuthalaly36523@direct.acumenmd.com

Organizations & group practices 8

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 10

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457375586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE",
            "address_2": "STE. 510",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045649",
            "telephone_number": "918-747-5200",
            "fax_number": "918-748-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE",
            "address_2": "STE. 510",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045649",
            "telephone_number": "918-747-5200",
            "fax_number": "918-748-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTHALALY",
        "first_name": "BOBBY",
        "middle_name": "KOSHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "20881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.