Pooja C Mittal, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A8712 Issued in CA

Practice address

955 Potrero Ave
Building 80 Ward 83
San Francisco, CA 94110

Phone

(415) 443-6810

Fax

(415) 443-8387

NPI assigned

Jan 10, 2006

Last updated

Sep 11, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Family Practice

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South County Community Health Center IncGroup PAC ID 3577474634, shared by 4 NPIs, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: pmittal19760@smch.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of San Mateo

  dba San Mateo Medical Center

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  Medicare reassignment
• Boston University Family Medicine, Inc.

  • Family Medicine Physician
  • Boston, MA
  • NPI 1134166390
  NPD (past)

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1215916200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 POTRERO AVENUE",
            "address_2": "BUILDING 80 WARD 83",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94110",
            "telephone_number": "415-443-6810",
            "fax_number": "415-443-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 POTRERO AVE",
            "address_2": "BUILDING 80 WARD 83",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94110",
            "telephone_number": "415-443-6810",
            "fax_number": "415-443-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTAL",
        "first_name": "POOJA",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "225413",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A8712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2107953",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selene Louise Mitlyng, PH.D.
• Elliot Jonathan Mitmaker, MD
• Siddhartha Mitra, MD, PHD
• John Mitre, MD
• Fumi Mitsuishi, M.D., M.S.
• Hisaaki Miura
• Nekissia Nicole Mixon
• Liana Aubrey Mixson, MD
• Kari Leilani Miya
• Navarre Miya, LAC

• Family Medicine Physician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.