NPIMap

Individual provider Active NPI

Pranav Raghuvir Mehta, M.D.

  • Family Medicine Physician
  • Yucaipa, CA
National Provider Identifier
1467527762
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G078698 Issued in CA
Practice address
12047 4TH St
Yucaipa, CA 92399-2735
Phone
(909) 797-5101
Fax
(909) 797-5103
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

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 G078698 CA Primary

Addresses

Primary practice location

12047 4TH St
Yucaipa, CA 92399-2735

Mailing address

12047 4TH St
Yucaipa, CA 92399-2735
Phone (909) 797-5101

Other identifiers 1

IdentifierTypeStateIssuer
07869800GMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080305000352 CA Practitioner - Family Practice 7719062421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York Medical College, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12047 4TH St
Yucaipa, CA 92399-2735
Phone 909797510112

Hospital & facility affiliations

  • Redlands Community Hospital Home Health Care Services Home health agency, Redlands, CA, CCN 057494
  • Med Care Plus Home Health Inc Home health agency, Pasadena, CA, CCN 058155
  • Redlands Community Hospital Hospital, Redlands, CA, CCN 050272
  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327
  • St Bernardine Medical Center Hospital, San Bernardino, CA, CCN 050129

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G078698CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pranav R. Mehta, M.D., Inc. Family Medicine CurrentSince Aug 4, 2003 Accepting new patients

Locations

12047 4th St
Yucaipa, CA 92399
Phone (840) 258-0972

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Redlands Community HospitalRedlands, CA, CCN 050272 Hospital Corporate Director Apr 1, 2006
Redlands Community Hospital Home Health Care ServicesRedlands, CA, CCN 057494 Home health agency Corporate Director Apr 1, 2006
Redlands Community HospitalRedlands, CA, CCN 051534 Hospice Corporate Director Apr 1, 2006

Owned or controlled facilities with NPI records 3

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

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.

Hospital & facility affiliations 5

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366243200000",
    "number": "1467527762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12047 4TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992735",
            "telephone_number": "909-797-5101",
            "fax_number": "909-797-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12047 4TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992735",
            "telephone_number": "909-797-5101",
            "fax_number": "909-797-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "PRANAV",
        "middle_name": "RAGHUVIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2013-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G078698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07869800G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucaipa, CA

Sources for this page

Verify at the official NPI Registry.