Individual provider Active NPI

Sawsawn Hayatdavoudi, M.D

  • Emergency Medicine Physician
  • San Jose, CA
National Provider Identifier
1265487649
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A84223 Issued in CA
Practice address
225 North Jackson Avenue
San Jose, CA 95116
Phone
(408) 923-7121
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A84223 CA Primary

Addresses

Primary practice location

225 North Jackson Avenue
San Jose, CA 95116

Mailing address

2100 Powell Street
Ste 920
Emeryville, CA 94608-1803
Phone (510) 350-2600

Other identifiers 1

IdentifierTypeStateIssuer
00A842230MedicaidCA

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
I20050913001175 CA Practitioner - Emergency Medicine 7810920576 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, Geffen School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

301 Industrial Rd
San Carlos, CA 94070-2603
Phone (650) 321-4121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A84223CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 16, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 16, 2020 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Oct 4, 2005 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Oct 4, 2005 Accepting new patients
El Camino Health Medical Group Past Accepting new patients
Southern Solano Emergency Medical Group, Inc Emergency Medicine Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
#1112
Palo Alto, CA 94301

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

301 Industrial Rd
San Carlos, CA 94070
Phone (650) 596-4000

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

300 Hospital Dr
Vallejo, CA 94589
Phone (707) 554-4107

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: shayatdavoudi8001@icare.elcaminohospital.org
  • Direct secure messaging: shayatdavoudi224158@hisp.ehr.sutterhealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1265487649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL STREET",
            "address_2": "STE 920",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081803",
            "telephone_number": "510-350-2600",
            "fax_number": "510-879-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 NORTH JACKSON AVENUE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95116",
            "telephone_number": "408-923-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYATDAVOUDI",
        "first_name": "SAWSAWN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A84223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A842230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.