Individual provider Active NPI

Dhaval I Patel, D.P.M

  • Foot & Ankle Surgery Podiatrist
  • Upland, CA
National Provider Identifier
1508152851
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5573 Issued in CA
Practice address
984 W Foothill Blvd Ste B
Upland, CA 91786-3787
Phone
(909) 920-0884
NPI assigned
Jun 24, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Foot & Ankle Surgery Podiatrist 213ES0103X E5573 CA Primary
Podiatrist 213E00000X E5573 CA

Addresses

Primary practice location

984 W Foothill Blvd Ste B
Upland, CA 91786-3787

Mailing address

10112 Foothill Blvd Unit 255
Rancho Cucamonga, CA 91730-0377
Phone (917) 774-6768

Other practice location 1

10112 Foothill Blvd Unit 255
Rancho Cucamonga, CA 91730-0377
Phone (917) 774-6768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140826001122 NY Practitioner - Podiatry 2163640608
I20230825000938 CA Practitioner - Podiatry 2163640608 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5573CAMDClinical Social Worker
E5573CAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jan David Tepper, DPM, Inc Foot & Ankle Surgery Current Accepting new patients
Wound Care Center of Socal PC Foot & Ankle Surgery CurrentSince May 1, 2023 Accepting new patients

Locations

984 W Foothill Blvd
Ste B
Upland, CA 91786
Phone (909) 920-0884

984 W Foothill Blvd
Ste A
Upland, CA 91786
Phone (909) 920-0884

Interoperability endpoints

  • Direct secure messaging: dpatel@jdtdpm.emadirect.md

Organizations & group practices 3

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": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1508152851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10112 FOOTHILL BLVD UNIT 255",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300377",
            "telephone_number": "917-774-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 W FOOTHILL BLVD STE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863787",
            "telephone_number": "909-920-0884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10112 Foothill Blvd Unit 255",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917300377",
            "country_code": "US",
            "telephone_number": "917-774-6768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "DHAVAL",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "D.P.M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-24",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5573",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E5573",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.