Manjunath Shivamanya Kottalgi, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

48589 Issued in AZ

Practice address

612 W Baseline Rd
Mesa, AZ 85210-6041

Phone

(480) 834-9039

Fax

(480) 964-7802

NPI assigned

Nov 12, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, TX2 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 2

Specialty

NephrologyAlso: Internal Medicine

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner - University Super Specialists LLCGroup PAC ID 1850695255, 31 clinicians

DHHS IHS Phoenix AreaGroup PAC ID 2668649567, 72 clinicians

Desert Kidney Associates PLCGroup PAC ID 4284611286, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• 032545 South Mountain Dialysis Center (FMC) Dialysis facility, Phoenix, AZ, CCN 032545
• Usrc South Phoenix Dialysis facility, Phoenix, AZ, CCN 032583
• Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002
• Mercy Gilbert Medical Center Hospital, Gilbert, AZ, CCN 030119
• Summit Healthcare Regional Medical Center Hospital, Show Low, AZ, CCN 030062
• Banner Casa Grande Medical Center Hospital, Casa Grande, AZ, CCN 030016
• Banner Desert Medical Center Hospital, Mesa, AZ, CCN 030065

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkottalgi23261@direct.acumenmd.com

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.

• Desert Kidney Associates PLC

  • Nephrology Physician
  • Mesa, AZ
  • NPI 1144372905
  Medicare reassignment Care Compare group NPD
• DHHS IHS Phoenix Area

  • General Acute Care Hospital
  • Whiteriver, AZ
  • NPI 1427335140

  TX

  Medicare reassignment Care Compare group NPD
• Banner - University Super Specialists LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1740650555
  Medicare reassignment Care Compare group
• Gila River Health Care Corporation

  • Critical Access Hospital
  • Laveen, AZ
  • NPI 1376538231

  TX

  Medicare reassignment NPD
• Rajesh Shenava & Associates MD PA

  • Nephrology Physician
  • Houston, TX
  • NPI 1528388246

  Internal Medicine

  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  • Clinic/Center
  • Cibecue, AZ
  • NPI 1427335181
  NPD
• Gila River Health Care

  • Community/Behavioral Health Agency
  • Laveen, AZ
  • NPI 1598021495
  NPD
• Gila River Regional Behavioral Health Authority

  • Community/Behavioral Health Agency
  • Sacaton, AZ
  • NPI 1497880439
  NPD
• Clinica la Familia, PC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1780668921
  NPD (past)
• Renal Dimensions, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Queen Creek, AZ
  • NPI 1003976010
  NPD (past)

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

• Bio-Medical Applications of Arizona, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phoenix, AZ
  • NPI 1780796680

  Dialysis facility

  Care Compare affiliation Name & address match
• Dialysis Newco LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phoenix, AZ
  • NPI 1588947048

  Dialysis facility

  Care Compare affiliation Name & address match
• Banner - University Medical Center Phoenix

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1841224870
  Care Compare affiliation
• Banner Desert Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1720011810
  Care Compare affiliation
• Banner Health

  • General Acute Care Hospital
  • Casa Grande, AZ
  • NPI 1003232976
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1992735088
  Care Compare affiliation
• Summit Healthcare Association

  • Oncology Clinic/Center
  • Show Low, AZ
  • NPI 1083736128

  Hospital

  Care Compare affiliation
• Summit Healthcare Association

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271
  Care Compare affiliation
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400371200000",
    "number": "1497082432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 W BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106041",
            "telephone_number": "480-834-9039",
            "fax_number": "480-964-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 W BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106041",
            "telephone_number": "480-834-9039",
            "fax_number": "480-964-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVAMANYA KOTTALGI",
        "first_name": "MANJUNATH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-12",
        "last_updated": "2014-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125055930",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "48589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharla Dea Shipley, COTA
• Marcus Shipman
• Sarah A Shipp
• Alicia Shirley, MA, LPC
• Clark Sebastian Shirley, AT, ATC
• Katerina Shnaydman, DO
• David Ivan Shockey, MD
• Gerald Roy Shockey, M.D.
• Estefania Vasquez Shockley, OTR/L
• David Carl Shoemaker, RN

• Nephrology Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Nephrology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2014; 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.