Indra De, MD, PHD

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

C52396 Issued in CA

Practice address

1800 N California St
Stockton, CA 95204-6019

Phone

(209) 943-2000

NPI assigned

May 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Internal MedicineAlso: Infectious Disease

Education

Other, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Medical Center of Stockton Hospital, Stockton, CA, CCN 050084

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Indra de M.D., Inc.

  • Infectious Disease Physician
  • Stockton, CA
  • NPI 1316147986
  Medicare reassignment NPD Authorized official

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

• Port City Operating Company, LLC

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1528190931
  Care Compare affiliation

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657411200000",
    "number": "1154372951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 GLEN ABBY CIR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952191800",
            "telephone_number": "209-462-9100",
            "fax_number": "209-462-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046019",
            "telephone_number": "209-943-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 W Acacia St",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952032484",
            "country_code": "US",
            "telephone_number": "209-944-5550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE",
        "first_name": "INDRA",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2022-07-10",
        "certification_date": "2022-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "C52396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anaclara Vieira De Matos
• De Porres Healthcare Corporation
• Julissa De Santiago
• Patricia De Santiago
• Jceyonna R De Soto
• Kathryn E Deamer
• Degene Deshon Dean
• Shaquille Dean
• Nydea Deans
• Erica May Deaton

• Infectious Disease Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Infectious Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.