Individual provider Active NPI

Noushin Haddad-Tehrani, MD

  • Internal Medicine Physician
  • Walnut Creek, CA
National Provider Identifier
1215988878
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A69067 Issued in CA
Practice address
2621 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone
(925) 947-0417
NPI assigned
May 16, 2006
Last updated
Mar 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 049032 CT
Internal Medicine Physician 207R00000X A69067 CA Primary

Addresses

Primary practice location

2621 Shadelands Dr
Walnut Creek, CA 94598-2512

Mailing address

1450 Treat Blvd # 300
Walnut Creek, CA 94597-2168
Phone (925) 952-2828

Other identifiers 1

IdentifierTypeStateIssuer
008023135MedicaidCT

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
I20150504002482 CA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 2264627413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians

Practice addresses (Care Compare)

2621 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 947-0417

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A69067CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Internal Medicine CurrentSince Feb 9, 2015 Accepting new patients
Permanente Medical Group, Inc CurrentSince Feb 9, 2015 Accepting new patients
John Muir Physician Network CurrentSince Mar 30, 2020 Accepting new patients
Middlesex Hospital Internal Medicine CurrentSince Feb 4, 2013 Accepting new patients
Middlesex Hospital PastSince Feb 4, 2013 Accepting new patients
John Muir Health Past Accepting new patients

Locations

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

380 Civic Dr
Ste 100
Pleasant Hill, CA 94523
Phone (925) 284-3840

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

2621 Shadelands Dr
Walnut Creek, CA 94598
Phone (925) 947-0417

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

80 S Main St
Ste 102
Middletown, CT 06457
Phone (860) 358-6878

Interoperability endpoints

  • Direct secure messaging: nhaddadtehrani133219@ehr.johnmuirhealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1215988878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD # 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-952-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982512",
            "telephone_number": "925-947-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD-TEHRANI",
        "first_name": "NOUSHIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "049032",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A69067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008023135",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.