NPIMap

Individual provider Active NPI

Ajay Kumar Rachakonda, MD

  • Nephrology Physician
  • Visalia, CA
National Provider Identifier
1467605014
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
32759 Issued in SC
Practice address
202 W. Willow St.
Suite 302
Visalia, CA 93291-6238
Phone
(559) 228-6600
Fax
(559) 226-3709
NPI assigned
Oct 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 32759 SC Primary

Addresses

Primary practice location

202 W. Willow St.
Suite 302
Visalia, CA 93291-6238

Mailing address

568 E Herndon Ave
Suite 302
Fresno, CA 93720-2989
Phone (559) 228-6600

Other identifiers 1

IdentifierTypeStateIssuer
327596MedicaidSC

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
I20140130000132 CA Practitioner - NephrologyPractitioner - Internal Medicine 9830382860 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
George Washington University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
San Joaquin Kidney Clinic, IncGroup PAC ID 8527009158, 8 clinicians

Practice addresses (Care Compare)

1801 E March LN
Suite B265
Stockton, CA 95210-6655
Phone (209) 546-1868

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Joaquin CurrentSince Feb 17, 2018 Accepting new patients
San Joaquin Faculty Medical Group CurrentSince Feb 17, 2018 Accepting new patients
San Joaquin Kidney Clinic, Inc CurrentSince May 23, 2022 Accepting new patients
County of San Joaquin CurrentSince Feb 17, 2018 Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
St. Joseph'S Hospital, Yonkers Past Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
County of San Joaquin Past Accepting new patients
Dameron Hospital Association Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

801 S Ham Ln
Ste J
Lodi, CA 95242
Phone (209) 369-7336

1801 E March Ln
Ste B265
Stockton, CA 95210
Phone (209) 369-7336

1530 Bessie Ave
Ste 107
Tracy, CA 95376
Phone (209) 834-1443

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: arachakonda201610@hisp.ehr.sutterhealth.org

Organizations & group practices 9

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 10

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": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1467605014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 E HERNDON AVE",
            "address_2": "SUITE 302",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202989",
            "telephone_number": "559-228-6600",
            "fax_number": "559-226-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W. WILLOW ST.",
            "address_2": "SUITE 302",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916238",
            "telephone_number": "559-228-6600",
            "fax_number": "559-226-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACHAKONDA",
        "first_name": "AJAY",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-28",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "32759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "327596",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.