Individual provider Active NPI

Kumar Ram Mohan, MD

  • Gastroenterology Physician
  • Fresno, CA
National Provider Identifier
1710991112
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A30132 Issued in CA
Practice address
110 N Valeria St
Suite 503
Fresno, CA 93701-2168
Phone
(559) 485-6750
Fax
(559) 485-6221
NPI assigned
Jul 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A30132 CA Primary

Addresses

Primary practice location

110 N Valeria St
Suite 503
Fresno, CA 93701-2168

Mailing address

110 N Valeria St
Suite 503
Fresno, CA 93701-2168
Phone (559) 485-6750

Other identifiers 1

IdentifierTypeStateIssuer
4096616MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20090115000316 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 9830252998 Practice locations: Fresno, CA

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30132CAMDPeriodontist
A30132CAMDGastroenterology Physician

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710991112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N VALERIA ST",
            "address_2": "SUITE 503",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012168",
            "telephone_number": "559-485-6750",
            "fax_number": "559-485-6221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N VALERIA ST",
            "address_2": "SUITE 503",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012168",
            "telephone_number": "559-485-6750",
            "fax_number": "559-485-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "KUMAR",
        "middle_name": "RAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A30132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4096616",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.