NPIMap

Individual provider Active NPI

Kamla K Mishra, MD

  • Internal Medicine Physician
  • Pottsville, PA
National Provider Identifier
1972581924
Registry record updated Jan 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD059125L Issued in PA
Practice address
700 Schuylkill Manor Rd
Suite 5a
Pottsville, PA 17901-3849
Phone
(570) 516-9444
Fax
(570) 728-2360
NPI assigned
Jan 9, 2006
Last updated
Jan 12, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2017

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 MD059125L PA Primary

Addresses

Primary practice location

700 Schuylkill Manor Rd
Suite 5a
Pottsville, PA 17901-3849

Mailing address

82 Tunnel Rd
Pottsville, PA 17901-3869
Phone (570) 622-5455

Other identifiers 5

IdentifierTypeStateIssuer
CB00663OtherPARAILROAD MEDICARE PBA
0015971720004OtherPAMA
50070589OtherPAKEYSTONE
0015971720002MedicaidPA
50070589OtherPAKEYSTONE SPECIALIST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20070628000016 PA Practitioner - Internal Medicine 7719086925 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Integrated Medical Group P CGroup PAC ID 1355247180, 105 clinicians
Img Nursing Home Care, P.C.Group PAC ID 8628491735, 11 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

700 Schuylkill Manor Rd
Suite 5a
Pottsville, PA 17901-3849
Phone (570) 516-9444

82 Tunnel Rd
Pottsville, PA 17901-3869
Phone (570) 622-5455

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD059125LPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Img Nursing Home Care, P.C. CurrentSince Jul 1, 2020 Accepting new patients
Integrated Medical Group P C Internal Medicine CurrentSince Oct 11, 2016 Accepting new patients
Integrated Medical Group, P.C. CurrentSince Oct 11, 2016 Accepting new patients
Pottsville SNF Operations LLC Past Accepting new patients
Pottsville Operations LLC Past Accepting new patients
The Meadows at Pottsville for Nursing and Rehabilitation LLC Past Accepting new patients
Integrated Medical Group Internal Medicine Past Accepting new patients
SM Rehab & Nursing Center LLC Past Accepting new patients
Schuylkill Center Opco LLC Past Accepting new patients

Locations

420 S Jackson St
Pottsville, PA 17901
Phone (570) 621-5000

48 Tunnel Rd
Ste 104
Pottsville, PA 17901
Phone (570) 622-5555

700 Schuylkill Manor Rd
Ste 5A
Pottsville, PA 17901
Phone (570) 516-9444

82 Tunnel Rd
Pottsville, PA 17901
Phone (570) 622-5455

Interoperability endpoints

  • Direct secure messaging: kmishra@imgpc.medentdirect.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1972581924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 TUNNEL RD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013869",
            "telephone_number": "570-622-5455",
            "fax_number": "570-622-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SCHUYLKILL MANOR RD",
            "address_2": "SUITE 5A",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013849",
            "telephone_number": "570-516-9444",
            "fax_number": "570-728-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "KAMLA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-09",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD059125L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PBA",
            "identifier": "CB00663",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA",
            "identifier": "0015971720004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "50070589",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015971720002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE SPECIALIST",
            "identifier": "50070589",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

Verify at the official NPI Registry.