Individual provider Active NPI

Rathinam Krishna Moorthy, MD

  • Cardiovascular Disease Physician
  • Brandon, FL
National Provider Identifier
1962594747
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME0040574 Issued in FL
Practice address
301 E Robertson St
Brandon, FL 33594-5253
Phone
(813) 689-0331
Fax
(813) 653-1752
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME0040574 FL Primary

Addresses

Primary practice location

301 E Robertson St
Brandon, FL 33594-5253

Mailing address

301 E Robertson St
Brandon, FL 33594-5253
Phone (813) 689-0331

Other identifiers 1

IdentifierTypeStateIssuer
067882100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20080828000167 FL Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 0749356715 Reassigns benefits to 1 organization
Practice locations: Brandon, FL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medi Clinics Primary Care LLCGroup PAC ID 6608029152, 4 clinicians

Practice addresses (Care Compare)

502 S Macdill Ave
Tampa, FL 33609-3039
Phone (813) 465-9999

Hospital & facility affiliations

  • Seacoast Home Health Home health agency, Tampa, FL, CCN 108002

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medi Clinics Primary Care LLC CurrentSince Oct 1, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Optum Care Services Company Past Accepting new patients

Locations

301 E Robertson St
Brandon, FL 33511
Phone (813) 689-0331

502 S Macdill Ave
Tampa, FL 33609
Phone (813) 465-9999

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 1

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1962594747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E ROBERTSON ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335945253",
            "telephone_number": "813-689-0331",
            "fax_number": "813-653-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E ROBERTSON ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335945253",
            "telephone_number": "813-689-0331",
            "fax_number": "813-653-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORTHY",
        "first_name": "RATHINAM",
        "middle_name": "KRISHNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME0040574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067882100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.