Gollavelli Jyothi Krishna, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

P1190 Issued in TX

Practice address

208 Oak Dr S
Suite 700
Lake Jackson, TX 77566-5790

Phone

(979) 230-4852

Fax

(979) 230-4863

NPI assigned

Jun 20, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• The Gulf Coast Center

  • Psychiatry Physician
  • League City, TX
  • NPI 1245285899

  Psychiatry, TX

  Medicare reassignment Care Compare group NPD
• Andrews Center

  • Mental Health Counselor
  • Tyler, TX
  • NPI 1821064742

  Psychiatry, TX

  Medicare reassignment NPD
• Bluebonnet Trails Community MHMR Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Round Rock, TX
  • NPI 1730135864

  Psychiatry, TX

  Medicare reassignment NPD
• Burke Center

  • Psychiatry Physician
  • Lufkin, TX
  • NPI 1396792420

  Psychiatry, TX

  Medicare reassignment NPD
• Heart of Texas Region MHMR Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waco, TX
  • NPI 1639399132

  TX

  Medicare reassignment NPD
• Spindletop MHMR Services

  • Family Medicine Physician
  • Beaumont, TX
  • NPI 1952357550

  TX

  Medicare reassignment NPD
• Camino Real Community MHMR Center

  • Case Management Agency
  • Lytle, TX
  • NPI 1154411262

  TX

  Medicare reassignment
• Andrews Center -Pinkerton

  • Social Worker
  • Tyler, TX
  • NPI 1538604715
  NPD
• Bluebonnet Trails Community MHMR Center

  • Rural Health Clinic/Center
  • La Grange, TX
  • NPI 1518536309
  NPD
• Spindletop MHMR Services

  • Mental Health Counselor
  • Beaumont, TX
  • NPI 1467517656
  NPD
• The Gulf Coast Center

  • Mental Health Counselor
  • League City, TX
  • NPI 1538202270
  NPD (past)

Specialty

Psychiatry

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Gulf Coast Center 21 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457568000000",
    "number": "1871754036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 OAK DR S",
            "address_2": "SUITE 700",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665790",
            "telephone_number": "979-230-4852",
            "fax_number": "979-230-4863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 OAK DR S",
            "address_2": "SUITE 700",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665790",
            "telephone_number": "979-230-4852",
            "fax_number": "979-230-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNA",
        "first_name": "GOLLAVELLI",
        "middle_name": "JYOTHI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2016-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "193726",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "P1190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01688384",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Koury & Mitschke Dentistry Partnership
• Philip C Koury, DDS
• Ted Armstrong Kovacev, MD
• Blair William Krell, M.D.
• Krisbin Medical LLC
• Kristina Kirkland Kulcak, D.C.
• Kelley D Kweon, O.D.
• Bailey Victoria Laday
• Amy Catherine Laird-Payne, PYSICIAN ASSISTANT
• Lake Jackson Assisted Living, LTD.

• All providers in Lake Jackson, TX
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.