Active NPI
Jose Mathew Thekkekara, M.D.
- Psychiatry Physician
- Reno, NV
National Provider Identifier
1649314683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 8941
- Practice address
- 85 Kirman Ave Ste 200
Reno, NV 89502 - Phone
- (775) 982-2826
- Fax
- (775) 982-2865
- NPI assigned
- Feb 15, 2007
- Sex
- Male
- 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 | 8941 | NV | Primary |
Addresses
Primary practice location
85 Kirman Ave Ste 200
Reno, NV 89502
Mailing address
850 Harvard Way
Reno, NV 89502-2055
Phone (775) 982-5262
Other practice location 1
850 Mill St Ste 301
Reno, NV 89502-1484
Phone (775) 982-5000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649314683 | Medicaid | NV | |
| P01092343 | Other | NV | RR MEDICARE PIN |
| 11830250 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8941 | NV | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541376000000",
"number": "1649314683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 HARVARD WAY",
"city": "RENO",
"state": "NV",
"postal_code": "895022055",
"telephone_number": "775-982-5262",
"fax_number": "775-982-5496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 KIRMAN AVE STE 200",
"city": "RENO",
"state": "NV",
"postal_code": "89502",
"telephone_number": "775-982-2826",
"fax_number": "775-982-2865"
}
],
"practiceLocations": [
{
"address_1": "850 Mill St Ste 301",
"address_purpose": "LOCATION",
"city": "Reno",
"state": "NV",
"postal_code": "895021484",
"country_code": "US",
"telephone_number": "775-982-5000",
"fax_number": "775-982-5240",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEKKEKARA",
"first_name": "JOSE",
"middle_name": "MATHEW",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2018-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NV",
"license": "8941",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1649314683",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PIN",
"identifier": "P01092343",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11830250",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.