NPIMap

Organization Active NPI

David Desai MD Inc

  • Psychiatry Physician
  • Redlands, CA
National Provider Identifier
1174901128
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A1004997 Issued in CA
Legal business name
DAVID DESAI MD INC
Practice address
1030 Nevada St Ste 101
Redlands, CA 92374-2957
Phone
(909) 966-5500
Fax
(909) 966-5222
NPI assigned
May 11, 2015
Last updated
Jan 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Authorized official

Name
David Desai, MDNPI 1740451566
Title
Owner
Phone
(951) 530-3294

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A1004997 CA Primary

Addresses

Primary practice location

1030 Nevada St Ste 101
Redlands, CA 92374-2957

Mailing address

1030 Nevada St Ste 101
Redlands, CA 92374-2957
Phone (909) 966-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150713001240 CA Part B Supplier - Clinic/Group Practice 6204148794 Receives reassigned benefits from 15 practitioners
Practice locations: San Bernardino, CA

National Provider Directory

National Provider Directory

Locations

13800 Heacock St
Ste C114
Moreno Valley, CA 92553
Phone (909) 966-5500

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1174901128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 NEVADA ST STE 101",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742957",
            "telephone_number": "909-966-5500",
            "fax_number": "909-966-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NEVADA ST STE 101",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742957",
            "telephone_number": "909-966-5500",
            "fax_number": "909-966-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID DESAI MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-530-3294",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A1004997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.