Active NPI
Raathathulaksi Krishnamohan
- Family Medicine Physician
- Southgate, MI
National Provider Identifier
1992156418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301109859
- Practice address
- 13667 Eureka Rd
Southgate, MI 48195-1332 - Phone
- (734) 530-6777
- Fax
- (734) 681-1156
- NPI assigned
- Jun 27, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301109859 | MI | Primary |
Addresses
Primary practice location
13667 Eureka Rd
Southgate, MI 48195-1332
Mailing address
30 W Monroe St Ste 1200
Chicago, IL 60603-2420
Phone (312) 733-9730
Other practice location 1
401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-5605
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301109859 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osh-Mi Physicians Group PC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- rkrishnamohan623626@direct.hfhs.org
- raatha.krishnamohan@oakstreethealth.gwaydirect.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Greensboro, NC
- NPI 1033766092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589500800000",
"number": "1992156418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 W MONROE ST STE 1200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606032420",
"telephone_number": "312-733-9730",
"fax_number": "773-866-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13667 EUREKA RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481951332",
"telephone_number": "734-530-6777",
"fax_number": "734-681-1156"
}
],
"practiceLocations": [
{
"address_1": "401 S Ballenger Hwy",
"address_purpose": "LOCATION",
"city": "Flint",
"state": "MI",
"postal_code": "485323638",
"country_code": "US",
"telephone_number": "810-342-5605",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KRISHNAMOHAN",
"first_name": "RAATHATHULAKSI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-27",
"last_updated": "2020-05-15",
"certification_date": "2020-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301109859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.