NPIMap

Individual provider Active NPI

Madhan Mohan, MD

  • Internal Medicine Physician
  • Pineville, KY
National Provider Identifier
1669482816
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
29667 Issued in KY
Practice address
850 Riverview Rd
Pineville, KY 40977-1430
Phone
(606) 337-6047
Fax
(606) 337-0925
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 29667 KY Primary

Addresses

Primary practice location

850 Riverview Rd
Pineville, KY 40977-1430

Mailing address

850 Riverview Rd
PO Box 308
Pineville, KY 40977-1430
Phone (606) 337-6047

Other identifiers 1

IdentifierTypeStateIssuer
64296676MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080125000199 KY Practitioner - Family PracticePractitioner - General PracticePractitioner - Internal Medicine 8628085552
I20120920000714 TN Practitioner - Family Practice 8628085552 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ultacare Medical PLLCGroup PAC ID 4789687484, 52 clinicians

Practice addresses (Care Compare)

1225 E Weisgarber Rd
Suite 190
Knoxville, TN 37909-2696
Phone (423) 259-5002

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ultacare Medical PLLC CurrentSince Jan 11, 2026 Accepting new patients
Provider Partners Care Management LP CurrentSince Feb 23, 2026 Accepting new patients
First Creek Healthcare, Inc. Past Accepting new patients
Knoxville Opco LLC Past Accepting new patients

Locations

1225 E Weisgarber Rd
Ste 190
Knoxville, TN 37909
Phone (423) 259-5002

5261 Carrollton Pike
Ste A
Woodlawn, VA 24381

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pine Mountain Clinic PSCPineville, KY, CCN 188947 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Officer
Corporate Director
W-2 Managing Employee		 Oct 1, 1983
Oct 1, 1983
Oct 1, 1983
Oct 1, 1983

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Pine Mountain Clinic PSC
    • Internal Medicine Physician
    • Pineville, KY
    • NPI 1205054327

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1669482816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW RD",
            "address_2": "PO BOX 308",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-6047",
            "fax_number": "606-337-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW RD",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-6047",
            "fax_number": "606-337-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "MADHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "29667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64296676",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pineville, KY

Sources for this page

Verify at the official NPI Registry.