Individual provider Active NPI

Rishi Jagarlamudi, DO

  • Family Medicine Physician
  • Tracy, CA
National Provider Identifier
1043952229
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21891 Issued in CA
Practice address
2160 W Grant Line Rd Ste 230
Tracy, CA 95377-7334
Phone
(209) 832-8700
NPI assigned
Apr 8, 2022
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 21891 CA Primary

Addresses

Primary practice location

2160 W Grant Line Rd Ste 230
Tracy, CA 95377-7334

Mailing address

6301 Zink House Dr
Tracy, CA 95377-8634
Phone (925) 548-4372

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
I20250409000062 CA Order and Referring Only - Family PracticePractitioner - Family Practice 0840711909

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21891CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tracy Urgent Care, Inc CurrentSince Nov 24, 2024 Accepting new patients

Locations

2160 W Grant Line Rd
Ste 230
Tracy, CA 95377
Phone (209) 832-8700

Interoperability endpoints

  • Direct secure messaging: rjagarlamudi233600@hpmg.direct-ci.net

Organizations & group practices 1

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": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1043952229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 ZINK HOUSE DR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953778634",
            "telephone_number": "925-548-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD STE 230",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777334",
            "telephone_number": "209-832-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGARLAMUDI",
        "first_name": "RISHI",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-08",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "21891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

Verify at the official NPI Registry.