Physician Compare National Logo

Physician Compare National (NPI:1497082432)

HEALTHCARE PROVIDER: MANJUNATH SHIVAMANYA KOTTALGI M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information

NPI 1497082432
Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID 6608099254
Unique individual clinician ID assigned by PECOS
Professional Enrollment ID I20140721001019
Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name SHIVAMANYA KOTTALGI
Individual professional last name
Provider First Name MANJUNATH
Individual professional first name
Provider Gender M
The provider's gender if the provider is a person.

Medical School Information

Medical School Name OTHER
Individual professional's medical school
Graduation Year 2007
Individual professional's medical school graduation year
Primary Specialty NEPHROLOGY
Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1 INTERNAL MEDICINE
First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties INTERNAL MEDICINE
All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information

Organization Legal Name GILA RIVER HEALTH CARE CORPORATION
Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID 0648174185
Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members 133
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address 483 W SEED FARM RD
Group Practice or individual's line 1 address
Line 2 Street Address GRHC/HU HU
Group Practice or individual's line 2 address
City SACATON
Group Practice or individual's city
State AZ
Group Practice or individual's state
Zip Code 851470038
Group Practice or individual's zip code (9 digits when available)
Phone Number 6025281200
Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information

Hospital Affiliation CCN 1 030002
Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1 BANNER - UNIVERSITY MEDICAL CENTER PHOENIX
Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2 030065
Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2 BANNER DESERT MEDICAL CENTER
Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3 031308
Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3 HUHU KAM MEMORIAL HOSPITAL
Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4 030062
Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4 SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER
Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5 030016
Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5 BANNER CASA GRANDE MEDICAL CENTER
Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment Y

Copyright © 2007-2026 Data Labs Health. All rights reserved.