Avi J Hettena, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

G45263 Issued in CA

Practice address

6037 La Granada, Suite C
Rancho Santa Fe, CA 92067

Phone

(858) 756-2116

Fax

(858) 400-5113

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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.

• Hardison Medical Corporation

  • General Practice Physician
  • Encinitas, CA
  • NPI 1124508296
  NPD (past)
• Kelli C. Karches, M.D., Inc

  • Primary Care Clinic/Center
  • Rancho Santa Fe, CA
  • NPI 1598952939
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

• N/a N/a N/a Professional name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 11, 2017.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1013029487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7281",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "920677281",
            "telephone_number": "518-637-8637",
            "fax_number": "415-358-4754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6037 LA GRANADA, SUITE C",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "92067",
            "telephone_number": "858-756-2116",
            "fax_number": "858-400-5113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETTENA",
        "first_name": "AVI",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G45263",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G45263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G452630",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "110017611",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "credential": "N/A",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Bernard Gramlich, PHARM.D.
• George William Groth IV, M.D.
• Anna Monique Halbeisen, D.O.
• Juliann Michelle Hatt, DNP
• Jason C Helfrich, D.C.
• Jamaas Home Health Nursing Services, Inc.
• Jennifer Aldawoodi DMD, Professional Corp
• Kali West, LLC
• Katherine Witmeyer, OD, a Professional Optometric Corporation
• Kelli C. Karches, M.D., Inc

• All providers in Rancho Santa Fe, CA
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.