Individual provider Active NPI

Manohar Kola, M.D.

  • Cardiovascular Disease Physician
  • Decatur, IL
National Provider Identifier
1982786273
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036071409 Issued in IL
Practice address
1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800
Phone
(217) 422-6100
Fax
(833) 784-5326
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036-071409 IL
Cardiovascular Disease Physician 207RC0000X 036071409 IL Primary

Addresses

Primary practice location

1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800

Mailing address

1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800
Phone (217) 422-6100

Other practice location 1

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 422-6100

Other identifiers 2

IdentifierTypeStateIssuer
036071409MedicaidIL
060040114OtherILRAILROAD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkola100015@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20041118000234 IL Practitioner - Cardiovascular Disease (Cardiology) 0648234740 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-2966

1800 E Lake Shore Dr 6TH FLR
Decatur, IL 62521-3810
Phone (217) 422-6100

2 W Adams St
Sullivan, IL 61951-1943
Phone (217) 728-8316

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 422-6100

619 E Mason St
Springfield, IL 62701-1034
Phone (217) 788-0706

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-071409ILMDSpecialist
036071409ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Cardiovascular Consultants LTD Cardiovascular Disease CurrentSince Apr 1, 1999 Accepting new patients
St Marys Hospital Decatur of the Hospital Sisters of the Third Order CurrentSince Mar 1, 1994 Accepting new patients

Locations

409 W Oak St
Carbondale, IL 62901
Phone (618) 536-2565

1770 E Lake Shore Dr
Ste 105
Decatur, IL 62521
Phone (217) 329-1000

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

3 Saint Elizabeth Blvd
Ste 2800
O Fallon, IL 62269
Phone (618) 233-6044

619 E Mason St
#4P57
Springfield, IL 62701

619 E Mason St
Ste 4
Springfield, IL 62701

619 E Mason St
Ste 4P57
Springfield, IL 62701

3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406

Interoperability endpoints

  • Direct secure messaging: mkola100015@ewd.direct.hshs.org

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 6

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1982786273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 E LAKE SHORE DR STE 105",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213800",
            "telephone_number": "217-422-6100",
            "fax_number": "833-784-5326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 E LAKE SHORE DR STE 105",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213800",
            "telephone_number": "217-422-6100",
            "fax_number": "833-784-5326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625213810",
            "country_code": "US",
            "telephone_number": "217-422-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLA",
        "first_name": "MANOHAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-071409",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036071409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036071409",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "060040114",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkola100015@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1770 E Lake Shore Dr Ste 105",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625213800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.