Individual provider Active NPI

Kusum Lata, M.D

  • Cardiovascular Disease Physician
  • Stockton, CA
National Provider Identifier
1477884161
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A110487 Issued in CA
Practice address
1801 E March LN
#A-170
Stockton, CA 95210-6629
Phone
(209) 951-9885
NPI assigned
Jan 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A 110487 CA
Cardiovascular Disease Physician 207RC0000X A110487 CA Primary

Addresses

Primary practice location

1801 E March LN
#A-170
Stockton, CA 95210-6629

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 521-6097

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
I20100830000176 CA Practitioner - Interventional CardiologyPractitioner - Internal Medicine 8426172396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1409 E Briggsmore Ave
Modesto, CA 95355-2707
Phone (209) 524-1211

1700 Coffee Rd
Modesto, CA 95355-2803
Phone (209) 526-4500

2505 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2545 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2800 L St
Sacramento, CA 95816-5616

441 W Eaton Ave
Tracy, CA 95376-3420
Phone (209) 830-4062

445 W Eaton Ave
Tracy, CA 95376-3420
Phone (209) 524-1211

447 W Eaton Ave
Tracy, CA 95376-3420
Phone (209) 830-4062

473 W Eaton Ave
Tracy, CA 95376-3420
Phone (209) 833-3320

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

815 Court St
Jackson, CA 95642-2154

Hospital & facility affiliations

  • Sutter Tracy Community Hospital Hospital, Tracy, CA, CCN 050313
  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • Peninsula Medical Center Hospital, Burlingame, CA, CCN 050007

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting13
Varicose vein removal22
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Sep 6, 2016 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Sep 6, 2016 Accepting new patients
Dameron Hospital Association Cardiovascular Disease Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients

Locations

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

165 Saint Dominics Dr
Ste 201
Manteca, CA 95337
Phone (209) 239-0120

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

1801 E March Ln
Ste A170
Stockton, CA 95210
Phone (209) 477-5552

445 W Eaton Ave
Tracy, CA 95376
Phone (209) 830-4062

Organizations & group practices 7

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 4

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": "1263945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1477884161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-521-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN",
            "address_2": "#A-170",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-951-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATA",
        "first_name": "KUSUM",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-20",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A 110487",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A110487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.