Individual provider Active NPI

Manav Khullar, MD

  • Psychiatry Physician
  • Sacramento, CA
National Provider Identifier
1164653523
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
C159089 Issued in CA
Practice address
8120 Timberlake Way Ste 107
Sacramento, CA 95823-5413
Phone
(916) 924-6400
Fax
(916) 681-6188
NPI assigned
Aug 4, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301094820 MI
Psychiatry Physician 2084P0800X C159089 CA Primary

Addresses

Primary practice location

8120 Timberlake Way Ste 107
Sacramento, CA 95823-5413

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956
Phone (916) 861-1486

Other identifiers 1

IdentifierTypeStateIssuer
C159089OtherCAMEDICAL STATE LICENSE

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
I20190418001567 CA Practitioner - Psychiatry 4183868185 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

1792 Tribute Rd
Suite 350
Sacramento, CA 95815-4322
Phone (916) 924-6400

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C159089CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Apr 15, 2019 Accepting new patients
Dignity Health Medical Foundation CurrentSince Apr 15, 2019 Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

1792 Tribute Rd
Ste 350
Sacramento, CA 95815

8120 Timberlake Way
Ste 107
Sacramento, CA 95823
Phone (916) 681-6000

3000 Q St
Sacramento, CA 95816
Phone (916) 733-5701

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": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1164653523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956",
            "telephone_number": "916-861-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 TIMBERLAKE WAY STE 107",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958235413",
            "telephone_number": "916-924-6400",
            "fax_number": "916-681-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHULLAR",
        "first_name": "MANAV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301094820",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C159089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL STATE LICENSE",
            "identifier": "C159089",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.