NPIMap

Individual provider Active NPI

Shamala Mohanasundaram, M.D

  • Family Medicine Physician
  • Los Gatos, CA
National Provider Identifier
1063608743
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A112811 Issued in CA
Practice address
555 Knowles Dr
Suite 200
Los Gatos, CA 95032-1549
Phone
(408) 370-0200
Fax
(408) 370-0202
NPI assigned
Sep 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A12811 CA
Family Medicine Physician 207Q00000X A112811 CA Primary

Addresses

Primary practice location

555 Knowles Dr
Suite 200
Los Gatos, CA 95032-1549

Mailing address

555 Knowles Dr Ste 109
Los Gatos, CA 95032-1542
Phone (408) 370-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110425000451 CA Practitioner - Family Practice 6800071564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
El Camino Health Medical Network LLCGroup PAC ID 6103115183, 202 clinicians

Practice addresses (Care Compare)

555 Knowles Dr
Los Gatos, CA 95032-1542

815 Pollard Rd
Los Gatos, CA 95032-1438
Phone (408) 866-4070

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A112811CAMDFamily Medicine Physician
A12811CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
El Camino Health Medical Network, LLC CurrentSince Jan 6, 2025 Accepting new patients
El Camino Health Medical Group Past Accepting new patients

Locations

555 Knowles Dr
Ste 200
Los Gatos, CA 95032
Phone (408) 370-0200

555 Knowles Dr
Ste 109
Los Gatos, CA 95032
Phone (408) 370-0200

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

Interoperability endpoints

  • Direct secure messaging: smohanasundaram7495@icare.elcaminohospital.org

Organizations & group practices 2

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1063608743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 KNOWLES DR STE 109",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321542",
            "telephone_number": "408-370-0200",
            "fax_number": "408-370-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 KNOWLES DR",
            "address_2": "SUITE 200",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321549",
            "telephone_number": "408-370-0200",
            "fax_number": "408-370-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHANASUNDARAM",
        "first_name": "SHAMALA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-17",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A12811",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A112811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

Verify at the official NPI Registry.