Individual provider Active NPI

Kajan Mahadevan, MD

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1972164580
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
65585 Issued in TN
Practice address
Lamont St & Veterans Way
James H. Quillen VA Medical Center
Johnson City, TN 37604
Phone
(423) 926-1171
NPI assigned
Jun 25, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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 65585 TN Primary

Addresses

Primary practice location

Lamont St & Veterans Way
James H. Quillen VA Medical Center
Johnson City, TN 37604

Mailing address

PO Box 70622
Johnson City, TN 37614-1709
Phone (423) 439-6283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20220713003945 TN Practitioner - Internal Medicine 2961883582 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

1201 Bishop St
Union City, TN 38261-5403
Phone (731) 885-2410

7565 Dannaher Dr
Powell, TN 37849-4029
Phone (865) 859-8000

Hospital & facility affiliations

  • Physicians Regional Medical Center Hospital, Powell, TN, CCN 440120

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
App of Tennessee HM, PLLC CurrentSince Jul 11, 2022 Accepting new patients

Locations

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

10820 Parkside Dr
Knoxville, TN 37934
Phone (865) 218-7011

7565 Dannaher Dr
Powell, TN 37849
Phone (865) 545-8000

2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

Organizations & group practices 2

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": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1972164580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70622",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141709",
            "telephone_number": "423-439-6283",
            "fax_number": "423-439-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAMONT ST & VETERANS WAY",
            "address_2": "JAMES H. QUILLEN VA MEDICAL CENTER",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-926-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHADEVAN",
        "first_name": "KAJAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-25",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "65585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.