NPIMap

Individual provider Active NPI

Krishna Jatavallabhula Mohan, MD

  • Nephrology Physician
  • Covina, CA
National Provider Identifier
1477645786
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A34175 Issued in CA
Practice address
158 W College St
Covina, CA 91723
Phone
(626) 331-0175
Fax
(626) 967-3849
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 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 A34175 CA
Nephrology Physician 207RN0300X A34175 CA Primary

Addresses

Primary practice location

158 W College St
Covina, CA 91723

Mailing address

158 W College St
Covina, CA 91723
Phone (626) 331-0175

Other identifiers 1

IdentifierTypeStateIssuer
00A341750MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040416000395 CA Practitioner - Nephrology 3072424035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Krishna J Mohan M D IncGroup PAC ID 9830184217, 4 clinicians

Practice addresses (Care Compare)

171 W Cottage Dr
Covina, CA 91723-2010
Phone (626) 331-0175

Hospital & facility affiliations

  • Mohan Dialysis Center of Industry Dialysis facility, City of Industry, CA, CCN 052854
  • Mohan Dialysis Center of Glendora Dialysis facility, Glendora, CA, CCN 552538
  • Mohan Dialysis Center of Covina Dialysis facility, Covina, CA, CCN 052726
  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
  • Emanate Health Foothill Presbyterian Hospital Hospital, Glendora, CA, CCN 050597

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A34175CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Krishna J Mohan M D Inc Internal Medicine CurrentSince Sep 1, 1985 Accepting new patients
Emanate Health Medical Center Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Mohan Dialysis Center of Covina, Inc. PastSince Aug 10, 1992 Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

171 W Cottage Dr
#O
Covina, CA 91723
Phone (626) 859-2522

171 W Cottage Dr
Covina, CA 91723
Phone (626) 331-0175

158 W College St
Covina, CA 91723
Phone (626) 331-0175

1350 W Covina Blvd
San Dimas, CA 91773
Phone (909) 394-2745

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kjm103pcs@m209.primeclinicalsystems.direct-ci.com

Organizations & group practices 6

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 6

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1477645786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 W COLLEGE ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91723",
            "telephone_number": "626-331-0175",
            "fax_number": "626-967-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 W COLLEGE ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91723",
            "telephone_number": "626-331-0175",
            "fax_number": "626-967-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "KRISHNA",
        "middle_name": "JATAVALLABHULA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A34175",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A34175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A341750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.