NPIMap

Individual provider Active NPI

Mallikarjuna Nallegowda, M.D, DNB, MNAMS

  • Pain Medicine Physician
  • Pueblo, CO
National Provider Identifier
1770733743
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
52039 Issued in CO
Practice address
3676 Parker Blvd Ste 230
Pueblo, CO 81008-2213
Phone
(719) 553-2200
Fax
(833) 916-2049
NPI assigned
Sep 25, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 52039 CO Primary

Addresses

Primary practice location

3676 Parker Blvd Ste 230
Pueblo, CO 81008-2213

Mailing address

PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 557-3666

Other practice location 1

4112 Outlook Blvd Ste 290
Pueblo, CO 81008-1667
Phone (719) 553-2235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20130819000660 CO Practitioner - Pain ManagementPractitioner - Physical Medicine and Rehabilitation 9436391539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Clinic PCGroup PAC ID 4284524067, 36 clinicians

Practice addresses (Care Compare)

3676 Parker Blvd
Suite 290
Pueblo, CO 81008-2214
Phone (719) 553-2200

Hospital & facility affiliations

  • University of Colorado Health - Memorial Health Inpatient rehabilitation facility, Colorado Springs, CO, CCN 06T022
  • Parkview Medical Center Inpatient rehabilitation facility, Pueblo, CO, CCN 06T020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52039COMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Clinic PC CurrentSince Oct 1, 2018 Accepting new patients
Southern Colorado Clinic PC PastSince Mar 16, 2021 Accepting new patients
Southern Colorado Clinic PC PastSince Mar 5, 2023 Accepting new patients

Locations

4112 Outlook Blvd
Ste 290
Pueblo, CO 81008
Phone (719) 553-2235

3676 Parker Blvd
Ste 290
Pueblo, CO 81008
Phone (719) 553-2200

4112 Outlook Blvd
Ste 255
Pueblo, CO 81008
Phone (719) 253-7640

3676 Parker Blvd
Ste 230
Pueblo, CO 81008
Phone (719) 553-2200

Interoperability endpoints

  • Direct secure messaging: mallikarjuna.nallegowda.1@21306.direct.athenahealth.com

Organizations & group practices 3

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 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1770733743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810089000",
            "telephone_number": "719-557-3666",
            "fax_number": "719-557-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD STE 230",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082213",
            "telephone_number": "719-553-2200",
            "fax_number": "833-916-2049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4112 Outlook Blvd Ste 290",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810081667",
            "country_code": "US",
            "telephone_number": "719-553-2235",
            "fax_number": "833-916-2049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NALLEGOWDA",
        "first_name": "MALLIKARJUNA",
        "name_prefix": "Dr.",
        "credential": "M.D, DNB, MNAMS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-25",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CO",
            "license": "52039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.