NPIMap

Individual provider Active NPI

Mahaveer Mukkamalla, MD

  • Family Medicine Physician
  • Dover, OH
National Provider Identifier
1689866543
Registry record updated Nov 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.095311 Issued in OH
Practice address
204 S Bellevue Ave
Dover, OH 44622-9405
Phone
(330) 343-7950
Fax
(330) 343-7805
NPI assigned
Aug 15, 2007
Last updated
Nov 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.095311 OH Primary

Addresses

Primary practice location

204 S Bellevue Ave
Dover, OH 44622-9405

Mailing address

204 S Bellevue Ave
Dover, OH 44622-9405
Phone (330) 343-7950

Other identifiers 1

IdentifierTypeStateIssuer
35.095311OtherOHOHIO LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100722000171 OH Practitioner - Family Practice 3870625148 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Integrated Acute Care Services of Ohio LLCGroup PAC ID 9032527221, 232 clinicians

Practice addresses (Care Compare)

3300 Mercy Health Blvd
Cincinnati, OH 45211-1103
Phone (513) 215-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.095311OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs Integrated Acute Care Services of Ohio, LLC CurrentSince Apr 27, 2023 Accepting new patients
Inpatient Medical Services, Inc. Family Medicine CurrentSince Feb 1, 2018 Accepting new patients
Santibanez Pac Ohio Inc CurrentSince Oct 24, 2024 Accepting new patients
4M Hospitalist Services, LLC CurrentSince Jan 1, 2021 Accepting new patients
Altercare of Wadsworth Center for Rehabilitation & Nursing Care, Inc Past Accepting new patients
Summa Health System Past Accepting new patients
FHS Brimfield, Inc. Past Accepting new patients
Sanctuary Wadsworth LLC Past Accepting new patients
Embassy Longmeadow LLC Past Accepting new patients

Locations

400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297

29 N Adams St
Akron, OH 44304
Phone (330) 572-7293

4040 Embassy Pkwy
Ste 400
Akron, OH 44333
Phone (330) 576-4295

3300 Mercy Health Blvd
Cincinnati, OH 45211
Phone (513) 215-1114

3557 Embassy Pkwy
Fairlawn, OH 44333
Phone (330) 670-1005

1290 Fairchild Ave
Kent, OH 44240
Phone (330) 678-4912

6847 N Chestnut St
Ravenna, OH 44266
Phone (330) 296-9606

275 E Sunset Dr
Rittman, OH 44270
Phone (330) 927-2060

100 Medical Center Dr
Springfield, OH 45504
Phone (937) 523-1000

Interoperability endpoints

  • Direct secure messaging: mahaveermukkamalla@dpfm.allscriptsdirect.net
  • Direct secure messaging: mmukkamalla243015@ehrdirect.uhhospitals.org

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
Tamarack Ridge Health & RehabilitationKent, OH, CCN 366497 Skilled nursing facility Adp of the SNF Oct 1, 2022

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 9

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.

Hospital & facility affiliations 10

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": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385510400000",
    "number": "1689866543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 S BELLEVUE AVE",
            "city": "DOVER",
            "state": "OH",
            "postal_code": "446229405",
            "telephone_number": "330-343-7950",
            "fax_number": "330-343-7805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 S BELLEVUE AVE",
            "city": "DOVER",
            "state": "OH",
            "postal_code": "446229405",
            "telephone_number": "330-343-7950",
            "fax_number": "330-343-7805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKAMALLA",
        "first_name": "MAHAVEER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-15",
        "last_updated": "2013-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.095311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LICENSE",
            "identifier": "35.095311",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, OH

Sources for this page

Verify at the official NPI Registry.