Active NPI
Bereketeab Haileselassie, MD
- Pediatric Critical Care Medicine Physician
- Palo Alto, CA
National Provider Identifier
1295059996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- A143395
- Practice address
- 725 Welch Rd
Palo Alto, CA 94304-1601 - Phone
- (650) 497-8000
- NPI assigned
- Mar 24, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 60157762 | WA | |
| Pediatrics Physician | 208000000X | A143395 | CA | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | A143395 | CA | Primary |
Addresses
Primary practice location
725 Welch Rd
Palo Alto, CA 94304-1601
Mailing address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- University of Missouri, Kansas City, School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 498-7200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60157762 | WA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LPCH Medical Group Div of Lucile | Pediatrics | Current | Accepting new patients |
Locations
725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979
Interoperability endpoints
- bhaileselassie356542@hisp.ehr.sutterhealth.org
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712793600000",
"number": "1295059996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 WELCH RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041601",
"telephone_number": "650-497-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 WELCH RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041601",
"telephone_number": "650-497-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAILESELASSIE",
"first_name": "BEREKETEAB",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-24",
"last_updated": "2024-04-11",
"certification_date": "2024-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "60157762",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A143395",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "CA",
"license": "A143395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.