NPIMap

Organization Active NPI

Gaurav Datta MD Inc

  • Internal Medicine Physician
  • Elk Grove, CA
National Provider Identifier
1033735931
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GAURAV DATTA MD INC
Practice address
7510 Fortaleza Ave
Elk Grove, CA 95757-1769
Phone
(414) 336-8677
Fax
(925) 954-6958
NPI assigned
Jun 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Authorized official

Name
Gaurav Datta, MDNPI 1225184765
Title
Owner
Phone
(414) 336-8677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

7510 Fortaleza Ave
Elk Grove, CA 95757-1769

Mailing address

7510 Fortaleza Ave
Elk Grove, CA 95757-1769
Phone (414) 336-8677

Other practice location 1

26 Tamarisk
Moraga, CA 94556-3009
Phone (414) 336-8677

Other practice location 2

199 E Webster St
Colusa, CA 95932-2954
Phone (530) 619-0800

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL NA Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200625002405 CA Part B Supplier - Clinic/Group Practice 9234551920 Receives reassigned benefits from 2 practitioners
Practice locations: Lodi, CA; Vacaville, CA

National Provider Directory

National Provider Directory

Locations

1850 E 8th St
Davis, CA 95616
Phone (530) 756-1800

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1033735931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7510 FORTALEZA AVE",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957571769",
            "telephone_number": "414-336-8677",
            "fax_number": "925-954-6958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7510 FORTALEZA AVE",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957571769",
            "telephone_number": "414-336-8677",
            "fax_number": "925-954-6958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26 Tamarisk",
            "address_purpose": "LOCATION",
            "city": "Moraga",
            "state": "CA",
            "postal_code": "945563009",
            "country_code": "US",
            "telephone_number": "414-336-8677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "199 E Webster St",
            "address_purpose": "LOCATION",
            "city": "Colusa",
            "state": "CA",
            "postal_code": "959322954",
            "country_code": "US",
            "telephone_number": "530-619-0800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GAURAV DATTA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "DATTA",
        "authorized_official_first_name": "GAURAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-336-8677",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "MA",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "7510 Fortaleza Ave",
            "city": "Elk Grove",
            "state": "CA",
            "country_code": "US",
            "postal_code": "957571769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.