NPIMap

Individual provider Active NPI

Raghu Mukkamala, MD

  • Internal Medicine Physician
  • Montgomery, AL
National Provider Identifier
1720079395
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19804 Issued in AL
Practice address
1722 Pine St
Suite 309
Montgomery, AL 36106-1103
Phone
(334) 262-0342
Fax
(334) 262-0390
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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 19804 AL Primary

Addresses

Primary practice location

1722 Pine St
Suite 309
Montgomery, AL 36106-1103

Mailing address

1722 Pine St
Suite 309
Montgomery, AL 36106-1103
Phone (334) 262-0342

Other identifiers 1

IdentifierTypeStateIssuer
19804OtherALSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20101202000933 AL Practitioner - Internal Medicine 7719173806 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
East Tennessee State University Quillen College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Internists of Montgomery, P.C.Group PAC ID 9335131572, 6 clinicians

Practice addresses (Care Compare)

1722 Pine St
Suite 309
Montgomery, AL 36106-1136
Phone (334) 262-0342

Hospital & facility affiliations

  • Amedisys Home Health of Montgomery Home health agency, Montgomery, AL, CCN 017319
  • Centerwell Home Health Home health agency, Prattville, AL, CCN 017055
  • Ivy Creek Home Health of Elmore Home health agency, Wetumpka, AL, CCN 017116
  • Enhabit Home Health Home health agency, Troy, AL, CCN 017324
  • Jackson Hospital & Clinic Inc Hospital, Montgomery, AL, CCN 010024
  • Baptist Medical Center South Hospital, Montgomery, AL, CCN 010023
  • Prattville Baptist Hospital Hospital, Prattville, AL, CCN 010108
  • Baptist Medical Center East Hospital, Montgomery, AL, CCN 010149

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19804ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Hospital and Clinic Inc. Internal Medicine CurrentSince Jun 28, 2011 Accepting new patients
Jackson Hospital & Clinic, Inc. CurrentSince Jun 28, 2011 Accepting new patients
Primary Care Internists of Montgomery, P.C. Internal Medicine CurrentSince Jan 13, 1997 Accepting new patients
Jackson Hospital and Clinic, Inc. Internal Medicine Current Accepting new patients

Locations

1722 Pine St
Ste 309
Montgomery, AL 36106
Phone (334) 262-0342

1722 Pine St
Ste 503
Montgomery, AL 36106
Phone (334) 240-2337

1725 Pine St
Montgomery, AL 36106
Phone (334) 293-8000

1758 Park Pl
Ste 300
Montgomery, AL 36106
Phone (334) 274-1204

11123 Chantilly Pkwy Ct
Unit L
Pike Road, AL 36064
Phone (334) 270-1151

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 8

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422403200000",
    "number": "1720079395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST",
            "address_2": "SUITE 309",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061103",
            "telephone_number": "334-262-0342",
            "fax_number": "334-262-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 PINE ST",
            "address_2": "SUITE 309",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061103",
            "telephone_number": "334-262-0342",
            "fax_number": "334-262-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKKAMALA",
        "first_name": "RAGHU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2015-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "19804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "19804",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.