Annell Mavrantonis-Kruithof, M.D.

Key facts

NPI

1497728018

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatry Physician 2084P0800X

License

C54623 (CA)

Practice address

1600 Eureka Rd
Roseville, CA 95661-3027

Phone

(916) 298-9885

NPI assigned

Feb 13, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 4

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.

• Permanente Medical Group Inc Internal Medicine Physician · Santa Clara, CA · NPI 1073606299
  Medicare reassignment Care Compare group NPD CA · PSYCHIATRY
• Permanente Medical Group, Inc. Clinical Medical Laboratory · Berkeley, CA · NPI 1083777163
  Care Compare group
• Permanente Medical Group Inc Internal Medicine Physician · San Francisco, CA · NPI 1841373800
  NPD PSYCHIATRY
• Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584
  NPD

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kaiser Foundation Hospitals General Acute Care Hospital · Roseville, CA · NPI 1073811378
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Psychiatry

Education

Loyola University of Chicago, Stritch School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group Inc (10,928 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital - Roseville Hospital · Roseville, CA · CCN 050772

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other names

• Annell Mavrantonis Professional name

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497728018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 EUREKA RD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613027",
            "telephone_number": "916-298-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 EUREKA RD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613027",
            "telephone_number": "916-298-9885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4250 AUBURN BLVD",
            "address_purpose": "LOCATION",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958414100",
            "country_code": "US",
            "telephone_number": "916-288-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAVRANTONIS-KRUITHOF",
        "first_name": "ANNELL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2022-07-21",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C54623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1600 Eureka Rd",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANNELL",
            "last_name": "MAVRANTONIS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Roseville, CA

• Melissa Maturino
• Christina Matusiak
• Onesty Maurice
• Adam Xu Mauricio, MD
• Maverly One LLC
• Maxim Healthcare Services, Inc.
• Maxim Healthcare Services, Inc.
• Rachel Maxim, LM, IBCLC
• Maxview, Inc
• Dave Maxwell

All providers in Roseville, CA · Psychiatry Physician in California