Individual provider Active NPI

Chandima Jinani Herath Mudiyanselage, M.D.

  • Internal Medicine Physician
  • Powell, TN
National Provider Identifier
1992327969
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
70459 Issued in TN
Practice address
7565 Dannaher Dr
Powell, TN 37849-4029
Phone
(865) 859-8000
NPI assigned
May 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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 70459 TN Primary

Addresses

Primary practice location

7565 Dannaher Dr
Powell, TN 37849-4029

Mailing address

4201 St. Antoine
Uhc 9C
Detroit, MI 48201
Phone (313) 745-5147

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
I20241212001563 TN Practitioner - Internal Medicine 9638592157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
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)

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

State licenses

LicenseStateTypeSpecialty
70459TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Sep 1, 2024 Accepting new patients

Locations

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

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

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

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

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.

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": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1992327969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ST. ANTOINE",
            "address_2": "UHC 9C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-5147",
            "fax_number": "313-993-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7565 DANNAHER DR",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "378494029",
            "telephone_number": "865-859-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERATH MUDIYANSELAGE",
        "first_name": "CHANDIMA",
        "middle_name": "JINANI",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "70459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Powell, TN

Sources for this page

Verify at the official NPI Registry.