Active NPI
Srividya A Mahendran, M.D.
- Pediatrics Physician
- San Diego, CA
National Provider Identifier
1487843454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A92173
- Practice address
- 4305 Univerisity Avenue Suite 150
San Diego Family Care, Dba Mid-City Community Clinic-Pe
San Diego, CA 92105-1601 - Phone
- (619) 280-2058
- Fax
- (858) 633-4682
- NPI assigned
- Oct 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A92173 | CA | Primary |
Addresses
Primary practice location
4305 Univerisity Avenue Suite 150
San Diego Family Care, Dba Mid-City Community Clinic-Pe
San Diego, CA 92105-1601
Mailing address
4305 University Avenue Suite 150
San Diego Family Care, Dba Mid-City Community Clinic-Pe
San Diego, CA 92105-1601
Phone (619) 280-2058
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260601002731 | CA | Order and Referring Only - Pediatric Medicine | 5193888980 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A92173 | CA | MD | Pediatrics Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484697600000",
"number": "1487843454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4305 UNIVERSITY AVENUE SUITE 150",
"address_2": "SAN DIEGO FAMILY CARE, DBA MID-CITY COMMUNITY CLINIC-PE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051601",
"telephone_number": "619-280-2058",
"fax_number": "858-633-4682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4305 UNIVERISITY AVENUE SUITE 150",
"address_2": "SAN DIEGO FAMILY CARE, DBA MID-CITY COMMUNITY CLINIC-PE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051601",
"telephone_number": "619-280-2058",
"fax_number": "858-633-4682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHENDRAN",
"first_name": "SRIVIDYA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-16",
"last_updated": "2017-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A92173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.