Individual provider Active NPI

Rena Avital Ahdut, DC

  • Chiropractor
  • Danville, CA
National Provider Identifier
1225653298
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
34826 Issued in CA
Practice address
565 Sycamore Valley Rd W
Danville, CA 94526-3900
Phone
(925) 837-5595
Fax
(935) 837-6558
NPI assigned
Jun 15, 2020
Last updated
Jun 15, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 34826 CA Primary

Addresses

Primary practice location

565 Sycamore Valley Rd W
Danville, CA 94526-3900

Mailing address

32 Vintage Cir Unit 1337
Pleasanton, CA 94566-6674
Phone (253) 226-1496

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200803001825 CA Practitioner - Chiropractic 0840615290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2020
Medicare assignment
May accept Medicare assignment
Group practices
Alexander Chiropractic and Wellness IncGroup PAC ID 3870830607, 7 clinicians

Practice addresses (Care Compare)

2410 San Ramon Valley Blvd
Suite 115
San Ramon, CA 94583-1788
Phone (925) 838-2600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34826CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Zamora Chiropractic Inc Chiropractor CurrentSince Aug 23, 2020 Accepting new patients
Alexander Chiropractic Center Inc. Chiropractor PastSince Jul 1, 1999 Accepting new patients
Hall Family Chiropractic Inc Chiropractor PastSince Jun 21, 2020 Accepting new patients

Locations

565 Sycamore Valley Rd W
Danville, CA 94526
Phone (925) 837-5595

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1225653298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 VINTAGE CIR UNIT 1337",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945666674",
            "telephone_number": "253-226-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 SYCAMORE VALLEY RD W",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945263900",
            "telephone_number": "925-837-5595",
            "fax_number": "935-837-6558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHDUT",
        "first_name": "RENA",
        "middle_name": "AVITAL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.