Individual provider Active NPI

Manjot Kaur Dhaliwal, PA-C

  • Physician Assistant
  • Shafter, CA
National Provider Identifier
1114150703
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20477 Issued in CA
Practice address
655 S Central Valley Hwy
Shafter, CA 93263-2790
Phone
(661) 459-1900
Fax
(661) 459-1974
NPI assigned
Aug 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA20477 CA Primary

Addresses

Primary practice location

655 S Central Valley Hwy
Shafter, CA 93263-2790

Mailing address

659 S Central Valley Hwy
Shafter, CA 93263-2790
Phone (661) 459-1900

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150116000979 CA Practitioner - Physician Assistant 3971827163 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vanguard Medical CorporationGroup PAC ID 4587881685, 23 clinicians

Practice addresses (Care Compare)

565 Kern St
Shafter, CA 93263-2133
Phone (661) 746-4937

8150 Hageman Rd
Bakersfield, CA 93312-1959
Phone (661) 459-1010

Hospital & facility affiliations

  • Adventist Health Bakersfield Hospital, Bakersfield, CA, CCN 050455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA20477CAMDPhysician Assistant

Practice roles (7 of 8)

OrganizationSpecialtyStatusNew patients
Pinnacle Emergency Physicians of Bakersfield, a Professional Corp CurrentSince Nov 9, 2014 Accepting new patients
The Nephrology Group, Inc. Clinical Lab CurrentSince Mar 1, 2020 Accepting new patients
Vanguard Medical Corporation CurrentSince Sep 1, 2022 Accepting new patients
Vanguard Medical Corporation CurrentSince Sep 1, 2022 Accepting new patients
Jae J. Kim, M.D. Past Accepting new patients
Vanguard Medical Corporation Past Accepting new patients
Bakersfield Memorial Hospital Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

8150 Hageman Rd
Bakersfield, CA 93312
Phone (661) 459-1010

3933 Coffee Rd
#B
Bakersfield, CA 93308
Phone (661) 588-9999

568 E Herndon Ave
Ste 201
Fresno, CA 93720
Phone (559) 228-9660

565 Kern St
Shafter, CA 93263
Phone (661) 746-4937

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EJHHCA/Endpoint/EJHHCA

Organizations & group practices 10

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 1

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": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1114150703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "659 S CENTRAL VALLEY HWY",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932632790",
            "telephone_number": "661-459-1900",
            "fax_number": "661-459-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 S CENTRAL VALLEY HWY",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932632790",
            "telephone_number": "661-459-1900",
            "fax_number": "661-459-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHALIWAL",
        "first_name": "MANJOT",
        "middle_name": "KAUR",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-28",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shafter, CA

Sources for this page

Verify at the official NPI Registry.