Chandramohan G Mudaliar, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C19670 Issued in TX

Practice address

122O Fifth Ave
Fort Worth, TX 76104

Phone

(817) 332-3002

NPI assigned

Feb 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chandra G Mudaliar Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Addiction Medicine

Education

Other, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Siripurapu Associates PLLC Medical Associates of North TexasGroup PAC ID 5698086924, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Siripurapu Associates PLLC Medical Associates of North Texas

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1023495702
  Medicare reassignment Care Compare group NPD
• My Health My Resources of Tarrant County

  • Psychiatry Physician
  • Fort Worth, TX
  • NPI 1952423782
  Medicare reassignment NPD
• Suresh Kankanala M.D, P.a.

  • Primary Care Clinic/Center
  • Fort Worth, TX
  • NPI 1053762237
  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1699749077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122O FIFTH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-332-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122O FIFTH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-332-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDALIAR",
        "first_name": "CHANDRAMOHAN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "C19670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0989964-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANDRA",
            "last_name": "MUDALIAR",
            "middle_name": "G",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• MSPF-IV Ridgemar Oe, LP
• Mstarr Enterprises LLC
• MTM Vitalcare LLC
• Nsangana Muanankese
• Kasey Mucher, PHARMD
• Pavani Muddasani, MD
• Steven Anthony Mudrovich, MD
• Mueller Ophthalmology PLLC
• Amy Mueller, RN
• Brandice Mueller

• Internal Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.