NPIMap

Individual provider Active NPI

Manjula Muppu, MD

  • Family Medicine Physician
  • Livermore, CA
National Provider Identifier
1104088582
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A115266 Issued in CA
Practice address
76 Fenton St
Livermore, CA 94550-4144
Phone
(925) 443-1800
NPI assigned
Jun 27, 2008
Last updated
Dec 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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 A115266 CA Primary
Hospitalist Physician 208M00000X A115266 CA

Addresses

Primary practice location

76 Fenton St
Livermore, CA 94550-4144

Mailing address

76 Fenton St
Livermore, CA 94550-4144
Phone (925) 443-1800

Other identifiers 1

IdentifierTypeStateIssuer
A115266OtherCALIC NUMBER

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
I20110920000874 CA Practitioner - Family Practice 2769653906 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quantum Healthcare Medical Associates IncGroup PAC ID 5294647574, 109 clinicians

Practice addresses (Care Compare)

6001 Norris Canyon Rd
San Ramon, CA 94583-5400
Phone (209) 845-2553

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A115266CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Manjula Muppu MD PC CurrentSince Jun 13, 2015 Accepting new patients
Stanford Health Care Past Accepting new patients

Locations

6001 Norris Canyon Rd
San Ramon, CA 94583
Phone (925) 275-8273

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
All Saints MaubertSan Leandro, CA, CCN 555879 Skilled nursing facility Contracted Managing Employee Jan 1, 2023
All Saints Subacute & Transitional CareSan Leandro, CA, CCN 555809 Skilled nursing facility Contracted Managing Employee Jan 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1104088582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 FENTON ST",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504144",
            "telephone_number": "925-443-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 FENTON ST",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504144",
            "telephone_number": "925-443-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUPPU",
        "first_name": "MANJULA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-27",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A115266",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A115266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "A115266",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

Verify at the official NPI Registry.