Active NPI
Mohan D Potluri, MD
- General Practice Physician
- Albany, NY
National Provider Identifier
1730166232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 134947
- Practice address
- 1662 Central Ave
Albany, NY 12205-4001 - Phone
- (518) 869-9692
- Fax
- (518) 869-7220
- NPI assigned
- Dec 27, 2005
- Last updated
- May 5, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 134947 | NY | |
| General Practice Physician | 208D00000X | 134947 | NY | Primary |
Addresses
Primary practice location
1662 Central Ave
Albany, NY 12205-4001
Mailing address
1662 Central Ave
Albany, NY 12205-4001
Phone (518) 869-9692
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000401122001 | Other | BLUE SHIELD OF NENY | |
| 10001639 | Other | CDPHP | |
| 4544624 | Other | AETNA | |
| 52E592 | Other | BLUE CROSS BLUE SHIELD | |
| 5500530 | Other | GHI | |
| 55582 | Other | GHI HMO | |
| 9521451 | Other | GHI | |
| 01138 | Other | MVP | |
| 04B091 | Other | BLUE CROSS BLUE SHIELD | |
| 000401122000 | Other | BLUE SHIELD OF NENY | |
| 01146 | Other | MVP | |
| 000461122003 | Other | BLUE SHIELD OF NENY | |
| 53242 | Other | GHI HMO | |
| 000400079001 | Other | URGENT CARE | |
| 0061396 | Other | GHI | |
| 01137 | Other | MVP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304553600000",
"number": "1730166232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1662 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122054001",
"telephone_number": "518-869-9692",
"fax_number": "518-869-7220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1662 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122054001",
"telephone_number": "518-869-9692",
"fax_number": "518-869-7220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTLURI",
"first_name": "MOHAN",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-27",
"last_updated": "2011-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "134947",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NY",
"license": "134947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF NENY",
"identifier": "000401122001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10001639",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4544624",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "52E592",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "5500530",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "55582",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "9521451",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "01138",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "04B091",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF NENY",
"identifier": "000401122000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "01146",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF NENY",
"identifier": "000461122003",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "53242",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "URGENT CARE",
"identifier": "000400079001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0061396",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "01137",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.