Raj Patel

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

102841 Issued in CA

Practice address

1099 Pomona St
Crockett, CA 94525-1427

Phone

(510) 787-1081

NPI assigned

Jun 14, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bay Area Community Resources, Inc

  • Community/Behavioral Health Agency
  • El Cerrito, CA
  • NPI 1356478143
  NPD (past)
• Bay Area Community Resources, Inc

  dba Carquinez MS

  • Community/Behavioral Health Agency
  • Crockett, CA
  • NPI 1417410093
  NPD (past)

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1508396409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3219 PIERCE ST",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948045910",
            "telephone_number": "510-559-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 POMONA ST",
            "city": "CROCKETT",
            "state": "CA",
            "postal_code": "945251427",
            "telephone_number": "510-787-1081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1731 Prince St",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947032464",
            "country_code": "US",
            "telephone_number": "510-644-6313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "RAJ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-14",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "102841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie McCluer, MFT
• Sonja Phyllis New, MFC
• John The Phong Nguyen, M.D.
• Kevin Bernard Noonan, MD
• Elizabeth Marie Oberholtzer, PT
• Sophia A Reiff
• Dennis G Rolley
• Daniel Paul Ross
• Seneca Family of Agencies (Seneca Crisis ESTRTP Crockett)
• Mervyn Frank Silverman, M.D., M.P.H.

• Student in an Organized Health Care Education/Training Program in Crockett, CA
• Providers in Crockett, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.