Channaiah Srikanth Mysore

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

D77961 Issued in MD

Practice address

100 E Carroll St
Salisbury, MD 21801

Phone

(800) 749-5191

NPI assigned

Aug 31, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD, NC2 enrollments

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 2

Specialty

Neurology

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians

Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040
• Vidant Edgecombe Hospital Hospital, Tarboro, NC, CCN 340107
• Ecu Health North Hospital Hospital, Roanoke Rapids, NC, CCN 340151

Merit-based Incentive Payment System (MIPS)

Final score

96.95 of 100Reported as apm

Quality

82.44

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csrikanthmysore302529@direct.vidanthealth.com

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.

• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  Medicare reassignment Care Compare group NPD
• Tidalhealth Peninsula Regional, Inc.

  • Family Medicine Physician
  • Salisbury, MD
  • NPI 1184832040
  Medicare reassignment NPD
• Tidalhealth Specialty Care, LLC

  • Medical Specialty Clinic/Center
  • Salisbury, MD
  • NPI 1619504735
  Medicare reassignment NPD
• Tidalhealth Peninsula Regional, Inc.

  • Community/Retail Pharmacy
  • Salisbury, MD
  • NPI 1871031559
  NPD

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

• East Carolina Health - Heritage Inc

  • General Acute Care Hospital
  • Tarboro, NC
  • NPI 1699757393
  Care Compare affiliation
• Halifax Regional Medical Center Inc

  • General Acute Care Hospital
  • Roanoke Rapids, NC
  • NPI 1346273943
  Care Compare affiliation
• Pitt County Memorial Hospital Inc

  • General Acute Care Hospital
  • Washington, NC
  • NPI 1780359687
  Care Compare affiliation
• Pitt County Memorial Hospital, Inc

  • General Acute Care Hospital
  • Greenville, NC
  • NPI 1043218944
  Care Compare affiliation

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1881900652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015493",
            "telephone_number": "800-749-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21801",
            "telephone_number": "800-749-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYSORE",
        "first_name": "CHANNAIAH",
        "middle_name": "SRIKANTH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-31",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MD",
            "license": "D77961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csrikanthmysore302529@direct.vidanthealth.com",
            "affiliation": "N",
            "address_1": "2100 Stantonsburg Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278342818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Muse Integrative Care LLC
• Joshua Daniel Myers, PA C
• Kay Myers, PH.D.
• Myeyedr Optometry of Maryland, LLC
• Myorthos Maryland Orthodontics - Labbe PC
• Fakhira Nafees, DMD
• Emily Michele Naff
• William Joseph Nagel, MD
• Richard Stephen Nagler
• Logan Aleksandra Nalesnik, CRNP-FAMILY

• Neurology Physician in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Neurology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.