Mohan Penmetcha, M.D.

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

J9779 Issued in TX

Practice address

4217 Marsh Ridge Rd Ste 110
Carrollton, TX 75010-4416

Phone

(972) 307-3456

Fax

(972) 307-6789

NPI assigned

May 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Family Center Vitalehealth PLLC

  • Family Medicine Physician
  • Flower Mound, TX
  • NPI 1174025746
  NPD (past)

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1578514667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 MARSH RIDGE RD STE 110",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104416",
            "telephone_number": "972-307-3456",
            "fax_number": "972-307-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4217 MARSH RIDGE RD STE 110",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104416",
            "telephone_number": "972-307-3456",
            "fax_number": "972-307-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENMETCHA",
        "first_name": "MOHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "TX",
            "license": "J9779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041774305",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpenmetcha@direct.care360.com",
            "affiliation": "N",
            "address_1": "4217 Marsh Ridge Rd Ste 110",
            "city": "Carrollton",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750104416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peace of Mind Caregivers, Inc. (Comfort Keepers 940 & 941)
• Peace Valley Hospice Inc
• Chandler Grace Pearce, LCSW
• Mary Anne Peck, O.D.
• Amy Pelser, LMSW
• Jagneris Penson
• People First Pharmacy (People First Pharmacy LP)
• People First Pharmacy 2
• Peppermint Dental-Lewisville PLLC (IO Dentistry)
• Yairis Perez Parodis, FNP-C

• Rheumatology Physician in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Rheumatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.