Mohan Kumar Bangalore Puttaiah, MD
Individual provider Active NPI Family Medicine Physician · Lovington, NM
NPI 1619007697 · NPPES record last updated Dec 4, 2024
Key facts
- NPI
- 1619007697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD2019-0994 (NM)
- Practice address
- 1600 N Main Ave
Lovington, NM 88260-2830 - Phone
- (575) 396-6611
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fedko Emergency Physicians New Mexico, LLC
Prisma Health Urgent Care of South Carolina PC
Otero County Hospital Association
Curry Emergency Group LLC
Practice addresses (Care Compare)
1016 E Rooselvelt Ave
Grants, NM 87020-2118
Phone (505) 287-4446
131 Harbison Blvd
Suite a
Columbia, SC 29212-2226
Phone (803) 485-1400
2669 Scenic Dr
Alamogordo, NM 88310-8700
Phone (505) 439-6100
301 E Miel de Luna Ave
Tucumcari, NM 88401-3810
Phone (575) 461-7074
Hospital & facility affiliations
- Dr Dan C Trigg Memorial Hospital
- Roosevelt General Hospital
- Christus Southern New Mexico
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.35 of 100
- Quality
- 80.04
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN, SC, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070920000630 | MN | Practitioner - Family Practice |
8123098738 | Reassigns benefits to 1 organization |
| I20130311000388 | SC | Practitioner - Emergency Medicine |
8123098738 | Reassigns benefits to 2 organizations |
| I20200131001530 | NM | Practitioner - Family Practice | 8123098738 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-8828 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Musc Community Physicians | Current |
Accepting new patients | |
| Curry Emergency Group LLC | Current |
Accepting new patients | |
| Otero County Hospital Association | Current |
Accepting new patients | |
| Fedko Emergency Physicians New Mexico LLC | Current |
Accepting new patients | |
| Musc Community Physicians | Current |
Accepting new patients | |
| Prisma Health Urgent Care of South Carolina, PC | Current |
Accepting new patients | |
| Otero County Hospital Association | Current |
Accepting new patients | |
| Four Corners Emergency Physicians PLLC | Current |
Accepting new patients | |
| Glenns Ferry Health Center, Inc. | Past | Accepting new patients | |
| Michael a Rowley MD PA | Past | Accepting new patients |
Locations
2669 Scenic Dr
Alamogordo, NM 88310
Phone (505) 439-6100
2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141
1016 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-4446
42121 US Highway 70
Portales, NM 88130
Phone (505) 226-3627
301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000
506 North St
Bamberg, SC 29003
Phone (803) 245-6290
131 Harbison Blvd
Ste A
Columbia, SC 29212
Phone (803) 485-1400
2435 Forest Dr
Columbia, SC 29204
Phone (770) 874-6859
1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609
Interoperability endpoints
- mbangaloreputtaiah824861@direct.ghs.myhfn.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M-8828 | ID | |
| Family Medicine Physician | 207Q00000X | 35196 | SC | |
| Family Medicine Physician | 207Q00000X | 49480 | MN | |
| Family Medicine Physician | 207Q00000X | MD2019-0994 | NM | Yes |
Addresses
Primary practice location
1600 N Main Ave
Lovington, NM 88260-2830
Mailing address
1600 N Main Ave
Lovington, NM 88260-2830
Phone (575) 396-6611
Other practice location 1
10040 Two Notch Rd
Columbia, SC 29223-4396
Phone (208) 788-1153
Other practice location 2
131 Harbison Blvd Ste A
Columbia, SC 29212-2226
Phone (803) 485-1400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0-569-979-8 | Other | ID | ECFMG CERTIFICATION # |
| 00010145533 | Other | ID | BLUESHIELD OF IDAHO GF # |
| 000010145534 | Other | ID | BLUESHIELD OF IDAHO MH # |
| 000010145537 | Other | ID | BLUESHIELD OF IDAHO GV # |
| 58826 | Other | ID | BLUE CROSS OF IDAHO |
| 539004052 08 | Other | ID | I-94 # CLASS H1B1 |
| 806780500 | Medicaid | ID | |
| 0007241559 | Other | ID | AETNA ID # |
| 284867 | Other | ID | ALTIUS HEALTH PLAN BILL # |
| CS10257 | Other | ID | IDAHO CONTROLLED SUBST. # |
| M-8828 | Other | ID | IDAHO MEDICAL LICENSE # |
| P00161243 | Other | ID | RAILROAD MEDICARE BILL # |
Other names
- Mohan Kumar
Other providers in Lovington, NM
- Francisco Andres Arreola
- Aysha Nicole Arroyo
- Marcella Avila
- B&J Drug Inc
- Back in Motion Chiropractic LLC
- Rosalinda Barraza
- Katherine L Batton
- Curtis Beauvais
- Veronda Begay
- Neil M Berry
All providers in Lovington, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.