Individual provider Active NPI

Opal Patel, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lakewood, CA
National Provider Identifier
1114547056
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5914 Issued in CA
Practice address
5220 Clark Ave Ste 125
Lakewood, CA 90712-2623
Phone
(562) 804-1381
NPI assigned
Apr 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E5914 CA
Foot & Ankle Surgery Podiatrist 213ES0103X E5914 CA Primary

Addresses

Primary practice location

5220 Clark Ave Ste 125
Lakewood, CA 90712-2623

Mailing address

13618 Lyon PL
La Mirada, CA 90638-6522

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230801003478 CA Practitioner - Podiatry 2264893635 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E5914CAMDFoot & Ankle Surgery Podiatrist
5914CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey Demian Inc Foot & Ankle Surgery CurrentSince Jul 1, 2023 Accepting new patients
Lawrence Hodor, DPM, Inc Podiatrist Current Accepting new patients

Locations

17215 Studebaker Rd
Ste 108
Cerritos, CA 90703
Phone (310) 750-4511

5220 Clark Ave
Ste 125
Lakewood, CA 90712
Phone (562) 804-1381

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: opatel539543@direct.memorialcare.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.

NPI Registry JSON

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1114547056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13618 LYON PL",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906386522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 CLARK AVE STE 125",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122623",
            "telephone_number": "562-804-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "OPAL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-21",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E5914",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CA

Sources for this page

Verify at the official NPI Registry.