Active NPI
Kamala Premkumar, MD
- Psychiatry Physician
- Mesa, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 12897
- Practice address
- 570 W Brown Rd
Mesa, AZ 85201-3227 - Phone
- (480) 344-2002
- NPI assigned
- May 28, 2006
- Last updated
- Mar 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 12897 | AZ | Primary |
Addresses
Primary practice location
570 W Brown Rd
Mesa, AZ 85201-3227
Mailing address
2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 387698 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12897 | AZ | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Current | Accepting new patients | |
| District Medical Group, Inc | Family Medicine | Past | Accepting new patients |
Locations
570 W Brown Rd
Mesa, AZ 85201
Phone (480) 344-2000
2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015
3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520
2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043
2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298
5102 W Campbell Ave
Phoenix, AZ 85031
Phone (623) 848-5000
Interoperability endpoints
- kpremkumar5111@direct.valleywisehealth.org
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426723200000",
"number": "1629025226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 E THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850168034",
"telephone_number": "602-470-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "570 W BROWN RD",
"city": "MESA",
"state": "AZ",
"postal_code": "852013227",
"telephone_number": "480-344-2002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREMKUMAR",
"first_name": "KAMALA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-28",
"last_updated": "2015-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "12897",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "387698",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Mesa, AZ
- Premier Pain Management, LLC
- Premier Physicians Group, PLLC
- Premier Trauma Counseling LLC
- Premise Health of Arizona Medical PC (City of Mesa Health & Wellness Center)
- Premise Health of Arizona Medical PC (AT&T Mesa)
- Isadora Preston-Jones, RN
- Emma Catherine Preston
- Shea Prestwich, PA-C
- Carol Preuitt, LISAC
- Mackenzie Elizabeth Prew
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.