Individual provider Active NPI

Nita Patel, M.D.

  • Pediatrics Physician
  • Brentwood, CA
National Provider Identifier
1396759817
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C52978 Issued in CA
Practice address
2400 Balfour Rd
#229
Brentwood, CA 94513-4945
Phone
(925) 308-8113
Fax
(925) 308-8701
NPI assigned
Jul 28, 2006
Last updated
Dec 11, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD426585 PA
Pediatrics Physician 208000000X C52978 CA Primary

Addresses

Primary practice location

2400 Balfour Rd
#229
Brentwood, CA 94513-4945

Mailing address

1450 Treat Blvd
Ste 300
Walnut Creek, CA 94597-2168
Phone (925) 952-2888

Other identifiers 1

IdentifierTypeStateIssuer
1396759817MedicaidCA

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
I20110224000753 CA Practitioner - Pediatric Medicine 4284668906 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C52978CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Physician Network CurrentSince Feb 14, 2011 Accepting new patients

Locations

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

2400 Balfour Rd
Ste 229
Brentwood, CA 94513
Phone (925) 308-8113

1450 Treat Blvd
Ste 300
Walnut Creek, CA 94597

Interoperability endpoints

  • Direct secure messaging: npatel8278@ehr.johnmuirhealth.com

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, 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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1396759817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD",
            "address_2": "STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-952-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 BALFOUR RD",
            "address_2": "#229",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945134945",
            "telephone_number": "925-308-8113",
            "fax_number": "925-308-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "NITA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD426585",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C52978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396759817",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, CA

Sources for this page

Verify at the official NPI Registry.