Fremont Neurology Medical Associates Inc a Prof Medical Corp

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

G66263 Issued in CA

Legal business name

FREMONT NEUROLOGY MEDICAL ASSOCIATES INC A PROF MEDICAL CORP

Practice address

722 Mowry Ave
Fremont, CA 94536-4115

Phone

(510) 713-3390

Fax

(510) 713-3393

NPI assigned

Mar 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Prabhjot Singh Khalsa, M.D.NPI 1134189590

Title

President

Phone

(510) 713-3390

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prabhjot Singh Khalsa, M.D.

  • Neurology Physician
  • Fremont, CA
  • NPI 1134189590

  CA, Neurology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1144280660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364115",
            "telephone_number": "510-713-3390",
            "fax_number": "510-713-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364115",
            "telephone_number": "510-713-3390",
            "fax_number": "510-713-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT NEUROLOGY MEDICAL ASSOCIATES INC A PROF MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "KHALSA",
        "authorized_official_first_name": "PRABHJOT",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-713-3390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G66263",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "CA",
            "license": "G66263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G662631",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fremont Healthcare Operating Company, LP
• Fremont Hearing Aid Center
• Fremont Internal Medicine Medical Associates,Inc
• Fremont Medical Group, Inc.
• Fremont Nephrology Prof Corp
• Fremont Optometric Group
• Fremont Optometric Vision Care Center
• Fremont Oral & Maxillofacial Surgery
• Fremont Orthopaedic Medical Group, Apc
• Fremont Pain Treamtment Center

• All providers in Fremont, CA
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.