Pradeepa Selvakumar MD Inc, a California Professional Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRADEEPA SELVAKUMAR MD INC, A CALIFORNIA PROFESSIONAL CORPORATION

Practice address

101 S San Mateo Dr Ste 102
San Mateo, CA 94401-3840

Phone

(650) 435-8211

Fax

(844) 965-9436

NPI assigned

Feb 5, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Pradeepa Selvakumar, MDNPI 1912090226

Title

Owner

Phone

(650) 435-8211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Mateo Primary Care Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pradeepa Selvakumar, MD

  • Internal Medicine Physician
  • Greenbrae, CA
  • NPI 1912090226
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1013472950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2889 BAZE RD",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944033436",
            "telephone_number": "415-778-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S SAN MATEO DR STE 102",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013840",
            "telephone_number": "650-435-8211",
            "fax_number": "844-965-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRADEEPA SELVAKUMAR MD INC, A CALIFORNIA PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "SELVAKUMAR",
        "authorized_official_first_name": "PRADEEPA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-435-8211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER INSURANCES",
            "identifier": "1912090226",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Mateo Primary Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diana Crooks Powers, D.D.S.
• Thomas Jefferson Powers VI, DDS
• Milly Poz
• PPSS Health
• Mukund Jayant Prabakar, MD
• Suneha Sakshi Prakash
• Kalpana Prasai, DNP
• Bonnie Taylor Praught, FNP
• Chaundra Prehara, LMFT
• Premier Healthcare Services, LLC

• Internal Medicine Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.