Klea D. Bertakis, M.D., M.P.H.
Individual provider Active NPI Family Medicine Physician · Sacramento, CA
NPI 1508841602 · NPPES record last updated Apr 12, 2011
Key facts
- NPI
- 1508841602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G384680 (CA)
- Practice address
- 4860 Y St
Acc 1600
Sacramento, CA 95817-2307 - Phone
- (916) 734-3630
- Fax
- (916) 734-5550
- NPI assigned
- Dec 12, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081210000382 | CA | Practitioner - Family Practice | 1456412303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G384680 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the Univ of Ca | Family Medicine | Current |
Accepting new patients |
| Regents of the Univ of Ca | Current | Accepting new patients | |
| Regents of the Univ of Ca | Current |
Accepting new patients |
Locations
4860 Y St
#2300
Sacramento, CA 95817
4860 Y St
#1600
Sacramento, CA 95817
Phone (916) 734-3630
4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313
2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104
4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G384680 | CA | Yes |
Addresses
Primary practice location
4860 Y St
Acc 1600
Sacramento, CA 95817-2307
Mailing address
4860 Y St
Acc 2300
Sacramento, CA 95817-2307
Phone (916) 734-3167
Other providers in Sacramento, CA
- Samuel Liam Francis Berry
- Sharon Yvonne Berry
- Donovan Bersamina
- Liam Nathan Berson
- Lisa Anne Bertaccini
- Lakai Christian Cade Berteig
- Jane Bertolani
- Shea Bertolucci
- Ruth A. Bertsch
- Thomas Wayne Bertsch
All providers in Sacramento, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.