Individual provider Active NPI

Maddiha Payami, D.O.

  • Family Medicine Physician
  • Antioch, CA
National Provider Identifier
1336484104
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A14012 Issued in CA
Practice address
4053 Lone Tree Way Ste 101
Antioch, CA 94531-6210
Phone
(510) 204-5256
Fax
(510) 506-7728
NPI assigned
Dec 5, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A14012 CA Primary

Addresses

Primary practice location

4053 Lone Tree Way Ste 101
Antioch, CA 94531-6210

Mailing address

2350 W El Camino Real FL 2
Mountain View, CA 94040-6203
Phone (510) 204-5256

Other practice location 1

7031 SW 62nd Ave
South Miami, FL 33143-4701
Phone (305) 284-7500

Other identifiers 1

IdentifierTypeStateIssuer
20A14012OtherCASTATE MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

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
I20151019001766 CA Practitioner - Family Practice 4587973326 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Onclick Healthcare IncorporatedGroup PAC ID 9830511260, 63 clinicians
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

2710 Reddington Way
Brentwood, CA 94513-5268
Phone (818) 230-2116

4501 Sand Creek Rd
Antioch, CA 94531-8687
Phone (925) 813-6500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A14012CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Nov 18, 2020 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Nov 18, 2020 Accepting new patients
Permanente Medical Group Inc Family Medicine CurrentSince Jun 10, 2021 Accepting new patients

Locations

4501 Sand Creek Rd
Antioch, CA 94531
Phone (925) 813-6420

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

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

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

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

1550 Broadway
#2
San Diego, CA 92101
Phone (619) 515-2525

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

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

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

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

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

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

Organizations & group practices 5

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 1

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": "1354665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1336484104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 W EL CAMINO REAL FL 2",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940406203",
            "telephone_number": "510-204-5256",
            "fax_number": "510-506-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4053 LONE TREE WAY STE 101",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945316210",
            "telephone_number": "510-204-5256",
            "fax_number": "510-506-7728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7031 SW 62nd Ave",
            "address_purpose": "LOCATION",
            "city": "South Miami",
            "state": "FL",
            "postal_code": "331434701",
            "country_code": "US",
            "telephone_number": "305-284-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYAMI",
        "first_name": "MADDIHA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A14012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "20A14012",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4501 Sand Creek Rd",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945318687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

Verify at the official NPI Registry.