Individual provider Active NPI

Thana Krisdakumtorn, DPM

  • Sports Medicine Podiatrist
  • Palo Alto, CA
National Provider Identifier
1487765863
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine PodiatristTaxonomy code 213ES0000X
License
E4241 Issued in CA
Practice address
795 El Camino Real
Palo Alto, CA 94301-2302
Phone
(650) 330-4529
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine Podiatrist 213ES0000X E4241 CA Primary

Addresses

Primary practice location

795 El Camino Real
Palo Alto, CA 94301-2302

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 853-2986

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080807000467 CA Practitioner - Podiatry 2567536659 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, shared by 16 NPIs, 3,783 clinicians

Practice addresses (Care Compare)

2500 Grant Rd
Mountain View, CA 94040-4302
Phone (650) 940-7000

3838 California St
San Francisco, CA 94118-1506

701 E El Camino Real
Mountain View, CA 94040-2833
Phone (650) 691-6174

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue20
Removal of skin lesions1-10
Removal of nail tissue270
Removal or shaving of skin growth126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4241CAMDMental Health Counselor
E4241CAMDSports Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Oct 6, 2019 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 6, 2019 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 6, 2019 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 6, 2019 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince May 1, 2001 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince May 1, 2001 Accepting new patients
El Camino Hospital Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

3120 Kearney St
Fremont, CA 94538
Phone (650) 498-3600

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

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

701 E El Camino Real
#1
Mountain View, CA 94040
Phone (650) 404-8440

2350 W El Camino Real
Fl 2
Mountain View, CA 94040
Phone (650) 691-6174

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
#1112
Palo Alto, CA 94301

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

301 Industrial Rd
#1
San Carlos, CA 94070
Phone (650) 404-8455

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

2581 Samaritan Dr
Ste 308
San Jose, CA 95124
Phone (408) 355-1700

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: tkrisdakumtorn35208@hisp.ehr.sutterhealth.org

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583280000000",
    "number": "1487765863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-853-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 EL CAMINO REAL",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943012302",
            "telephone_number": "650-330-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISDAKUMTORN",
        "first_name": "THANA",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0000X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Sports Medicine",
            "state": "CA",
            "license": "E4241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.