Mohan Babu Palla, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

2025017659 Issued in MO

Practice address

1011 Bowles Ave Ste 300
Fenton, MO 63026-2387

Phone

(636) 496-5065

NPI assigned

Apr 30, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 10

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL, AK3 enrollments

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.

Enrollment records 3

Specialty

Interventional Cardiology

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mat-Su Valley III LLCGroup PAC ID 5496941502, 26 clinicians

Prairie Cardiovascular Consultants LTDGroup PAC ID 3173435880, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006
• Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001
• Alaska Regional Hospital Hospital, Anchorage, AK, CCN 020017
• St Johns Hospital Hospital, Springfield, IL, CCN 140053

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mohan.palla.1@2839.direct.athenahealth.com
• Direct secure messaging: mpalla475482@ewd.direct.hshs.org

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.

• Mat-Su Valley III LLC

  • Internal Medicine Physician
  • Palmer, AK
  • NPI 1366752560
  Medicare reassignment Care Compare group NPD
• Prairie Cardiovascular Consultants LTD

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1982714218

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1568787448
  Medicare reassignment NPD
• SSM Medical Group Inc.

  dba SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Warrenton, MO
  • NPI 1467997155
  NPD
• SSM Medical Group, Inc.

  dba SSM Health Medical Group

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207

  Internal Medicine

  NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Wauwatosa, WI
  • NPI 1154947224
  NPD
• Mat-Su Valley III LLC

  dba Mat Su Urgent Care - Palmer

  • Urgent Care Clinic/Center
  • Palmer, AK
  • NPI 1518472984
  NPD
• Kingman Healthcare, Inc

  • Specialist
  • Kingman, AZ
  • NPI 1689897787

  Internal Medicine

  NPD (past)
• Upmc Western Maryland Health Services, LLC

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1134844764
  NPD (past)

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

• Galen Hospital Alaska, Inc.

  dba Alaska Regional Hospital

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1952348047
  Care Compare affiliation
• Mat-Su Valley Medical Center LLC

  dba Mat-Su Regional Medical Center

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation
• Providence Health & Services Washington

  dba Providence Alaska Medical Center

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1053363119
  Care Compare affiliation
• St Johns Hospital of the Hospital Sisters of the Third Order of St F

  dba HSHS St. John's Hospital

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1205818481
  Care Compare affiliation

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749600000000",
    "number": "1477998896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831837",
            "telephone_number": "310-426-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 300",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262387",
            "telephone_number": "636-496-5065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12502 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026491",
            "country_code": "US",
            "telephone_number": "240-964-8724",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12500 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026393",
            "country_code": "US",
            "telephone_number": "240-964-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 E Mason St Ste 4P57",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627011034",
            "country_code": "US",
            "telephone_number": "217-788-0706",
            "fax_number": "217-525-2535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 Saint Antoine St",
            "address_2": "UHC-2E",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012153",
            "country_code": "US",
            "telephone_number": "313-745-4525",
            "fax_number": "313-745-4052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALLA",
        "first_name": "MOHAN",
        "middle_name": "BABU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-30",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D90794",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036160962",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MD",
            "license": "D90794",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036160962",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ND",
            "license": "21166",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MD",
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036160962",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MD",
            "license": "D9074",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2025017659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Cardiology Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Interventional Cardiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.