Individual provider Active NPI

Mamta Thukral, MD

  • Anesthesiology Physician
  • San Jose, CA
National Provider Identifier
1023079118
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
220401 Issued in MA
Practice address
Santa Teresa Medical Center
250 Hospital Parkway
San Jose, CA 95119
Phone
(408) 972-6164
NPI assigned
Mar 29, 2006
Last updated
Dec 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 220401 MA Primary

Addresses

Primary practice location

Santa Teresa Medical Center
250 Hospital Parkway
San Jose, CA 95119

Mailing address

3212 Whitesand Dr
San Jose, CA 95148-3807

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070505000155 CA Practitioner - Anesthesiology 3274566658 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
89962CAMDPharmacist
220401MAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Anesthesiology Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 8, 2010 Accepting new patients
Permanente Medical Group Inc Anesthesiology CurrentSince Dec 8, 2010 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
LPCH Medical Group Div of Lucile Past Accepting new patients
Stanford Health Care Anesthesiology Past Accepting new patients
CHMC Anesthesia Foundation Inc Anesthesiology PastSince Oct 2, 2022 Accepting new patients

Locations

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

250 Hospital Pkwy
San Jose, CA 95119
Phone (408) 972-6320

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1023079118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3212 WHITESAND DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951483807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SANTA TERESA MEDICAL CENTER",
            "address_2": "250 HOSPITAL PARKWAY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95119",
            "telephone_number": "408-972-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THUKRAL",
        "first_name": "MAMTA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "220401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "250 Hospital Pkwy",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951191103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.