Petr Utrata, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A54495 Issued in CA

Practice address

19100 Crest Ave Apt 24
Castro Valley, CA 94546-2863

Phone

(650) 288-8344

Fax

(510) 274-5503

NPI assigned

Oct 18, 2006

Last updated

Aug 4, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hayward Hills Operating Company, LP

  dba Hayward Hills Healthcare Center

  • Skilled Nursing Facility
  • Hayward, CA
  • NPI 1801868302

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1376624742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19100 CREST AVE APT 24",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945462863",
            "telephone_number": "510-357-1830",
            "fax_number": "510-274-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19100 CREST AVE APT 24",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945462863",
            "telephone_number": "650-288-8344",
            "fax_number": "510-274-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTRATA",
        "first_name": "PETR",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A54495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Merlene Tyra, FNP-C
• United Family Medical Supply, Inc. (Wisteria Care Center)
• University Healthcare Alliance
• Jenny Urias
• Yvonne Usher, D.C.
• Ketaki Vaidya
• Ramiyah Valentine
• Susie Valle, LMFT
• Valley Pointe Nursing and Rehabilitation Center, Inc.
• Valley Pointeidence Opco, LLC (Valley Pointe Nursing & Rehabilitation Center)

• Internal Medicine Physician in Castro Valley, CA
• Providers in Castro Valley, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.