NPIMap

Individual provider Active NPI

Mahesh Krishnamoorthy, M.D.

  • Internal Medicine Physician
  • Hagerstown, MD
National Provider Identifier
1962465666
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0061411 Issued in MD
Practice address
11110 Medical Campus Rd
Suite 150
Hagerstown, MD 21742-6700
Phone
(301) 665-4825
Fax
(301) 665-4826
NPI assigned
Apr 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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 D0061411 MD Primary

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 150
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Suite 150
Hagerstown, MD 21742-6700
Phone (301) 665-4825

Other identifiers 1

IdentifierTypeStateIssuer
404857100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20040719000221 MD Practitioner - Internal Medicine 1951380468 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians
Medical Practices of Antietam, LLCGroup PAC ID 2567353865, 229 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

11110 Medical Campus Rd
Suite 150
Hagerstown, MD 21742-6755
Phone (301) 665-4825

Hospital & facility affiliations

  • Home Call Home health agency, Frederick, MD, CCN 217040
  • Meritus Medical Center, Inc Home health agency, Hagerstown, MD, CCN 217085
  • Community Home Health Care, Inc. Home health agency, Chambersburg, PA, CCN 398068
  • Hospice of Washington County, Inc Hospice, Hagerstown, MD, CCN 211511

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0061411MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Practices of Antietam, LLC CurrentSince May 10, 2004 Accepting new patients
Meritus Urgent Care LLC CurrentSince Dec 1, 2015 Accepting new patients
Meritus Urgent Care, LLC CurrentSince Dec 1, 2015 Accepting new patients
Medical Practices of Antietam LLC CurrentSince May 10, 2004 Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients
Reddy Urgent Care - Royston LLC Internal Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

11110 Medical Campus Rd
Ste 150
Hagerstown, MD 21742
Phone (301) 665-4825

13620 Crayton Blvd
Hagerstown, MD 21742
Phone (240) 313-3100

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 7

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 4

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1962465666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 150",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-665-4825",
            "fax_number": "301-665-4826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 150",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-665-4825",
            "fax_number": "301-665-4826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAMOORTHY",
        "first_name": "MAHESH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0061411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404857100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.