NPIMap

Individual provider Active NPI

Ponnaiah C. Mohan, MD

  • Nephrology Physician
  • Arlington, TX
National Provider Identifier
1487646295
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
M1245 Issued in TX
Practice address
3125 Matlock Rd Ste 107
Arlington, TX 76015-2905
Phone
(817) 899-8109
Fax
(888) 878-5157
NPI assigned
Aug 17, 2005
Last updated
Jun 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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 M1245 TX Primary

Addresses

Primary practice location

3125 Matlock Rd Ste 107
Arlington, TX 76015-2905

Mailing address

PO Box 92
Shannon, AL 35142-0092
Phone (888) 212-4243

Other practice location 1

2605 Highland Park Ct
Colleyville, TX 76034
Phone (888) 212-4243

Other identifiers 3

IdentifierTypeStateIssuer
P00262936OtherTXRR MEDICARE
173763701MedicaidTX
8226BOOtherTXBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20050628001462 TX Practitioner - NephrologyPractitioner - Internal Medicine 8224074497 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Renal Specialists of North Texas PLLCGroup PAC ID 0446597850, 3 clinicians

Practice addresses (Care Compare)

3301 Matlock Rd
Arlington, TX 76015-2908
Phone (888) 212-4243

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Renal Specialists of North Texas PLLC Nephrology CurrentSince Dec 17, 2018 Accepting new patients
Acclaim Physician Group, Inc CurrentSince May 1, 2016 Accepting new patients
Usrc Mansfield LLC PastSince Apr 1, 2021 Accepting new patients
SNG - Sohum Southeast Houston Dialysis Center LP PastSince Dec 31, 2012 Accepting new patients

Locations

1000 N Cooper St
Arlington, TX 76011
Phone (817) 548-3400

3125 Matlock Rd
Ste 107
Arlington, TX 76015
Phone (817) 899-8109

3301 Matlock Rd
Arlington, TX 76015
Phone (682) 509-6200

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

2700 E Broad St
Mansfield, TX 76063
Phone (682) 242-2000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IAEGBD

Organizations & group practices 4

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.

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": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1487646295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "SHANNON",
            "state": "AL",
            "postal_code": "351420092",
            "telephone_number": "888-212-4243",
            "fax_number": "888-878-5157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 MATLOCK RD STE 107",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152905",
            "telephone_number": "817-899-8109",
            "fax_number": "888-878-5157"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2605 Highland Park Ct",
            "address_purpose": "LOCATION",
            "city": "Colleyville",
            "state": "TX",
            "postal_code": "76034",
            "country_code": "US",
            "telephone_number": "888-212-4243",
            "fax_number": "888-878-5157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "PONNAIAH",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "M1245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00262936",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173763701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8226BO",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.