Individual provider Active NPI

Rupa Sehgal Reddy, D.O.

  • Dermatology Physician
  • Yorba Linda, CA
National Provider Identifier
1114183464
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20A9765 Issued in CA
Practice address
4300 Rose Dr
Yorba Linda, CA 92886-2026
Phone
(714) 528-4211
Fax
(714) 579-6868
NPI assigned
Aug 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X OS10211 FL
Dermatology Physician 207N00000X 20A9765 CA Primary

Addresses

Primary practice location

4300 Rose Dr
Yorba Linda, CA 92886-2026

Mailing address

4300 Rose Dr
Yorba Linda, CA 92886-2026

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rreddy1374180@oc.providencedirect.org

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
I20110822000303 CA Practitioner - DermatologyPractitioner - Micrographic Dermatologic Surgery (MDS) 7517137904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Micrographic Dermatologic Surgery (MDS)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1514 Valley Vista Dr
Diamond Bar, CA 91765-3929
Phone (909) 860-1144

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

4300 Rose Dr
Yorba Linda, CA 92886-2026
Phone (714) 577-6601

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision25
Removal of skin lesions345
Removal of skin cancer107
Skin biopsy149

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A9765CAMDDermatology Physician
OS10211FLMDDermatology Physician
9765CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Aug 16, 2011 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 16, 2011 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Queen of the Valley Medical Association Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

955 W Imperial Hwy
Ste 200
Brea, CA 92821
Phone (714) 449-6900

1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

4300 Rose Dr
Yorba Linda, CA 92886
Phone (714) 528-4211

4300 Rose Dr
Ste J
Yorba Linda, CA 92886
Phone (714) 577-6666

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: rreddy1374180@oc.providencedirect.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1114183464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 ROSE DR",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928862026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 ROSE DR",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928862026",
            "telephone_number": "714-528-4211",
            "fax_number": "714-579-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "RUPA",
        "middle_name": "SEHGAL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-05",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS10211",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "20A9765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rreddy1374180@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4300 Rose Dr",
            "city": "Yorba Linda",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928862026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Yorba Linda, CA

Sources for this page

Verify at the official NPI Registry.