Active NPI
John T Azevedo, RD
- Registered Dietitian
- Elk Grove, CA
National Provider Identifier
1053947564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86023720
- Practice address
- 9451 Windrunner LN
Elk Grove, CA 95758-4636 - Phone
- (916) 668-9206
- NPI assigned
- Mar 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86023720 | CA | Primary |
Addresses
Primary practice location
9451 Windrunner LN
Elk Grove, CA 95758-4636
Mailing address
9451 Windrunner LN
Elk Grove, CA 95758-4636
Phone (209) 604-9003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211124001408 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 1850781311 | Practice locations: Elk Grove, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
Elk Grove, CA 95758
Phone (916) 668-9206
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86023720 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637107200000",
"number": "1053947564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9451 WINDRUNNER LN",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957584636",
"telephone_number": "209-604-9003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9451 WINDRUNNER LN",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957584636",
"telephone_number": "916-668-9206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AZEVEDO",
"first_name": "JOHN",
"middle_name": "T",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-16",
"last_updated": "2021-11-17",
"certification_date": "2021-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86023720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Nov 17, 2021; 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.