NPIMap

Individual provider Active NPI

Andrew J Tak, MD

  • Internal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1528158953
Registry record updated Jun 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G78315 Issued in CA
Practice address
1111 Exposition Blvd
BLDG 400a
Sacramento, CA 95815-4314
Phone
(916) 646-4583
Fax
(916) 646-4056
NPI assigned
Oct 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G78315 CA Primary

Addresses

Primary practice location

1111 Exposition Blvd
BLDG 400a
Sacramento, CA 95815-4314

Mailing address

PO Box 4578
Davis, CA 95617
Phone (916) 646-4583

Other identifiers 1

IdentifierTypeStateIssuer
00G783150MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040220000453 CA Practitioner - Internal Medicine 8022903707 Practice locations: Sacramento, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1111 Exposition Blvd
Suite 400a
Sacramento, CA 95815-4336
Phone (916) 646-4583

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G78315CAMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: atak13409@hisp.ehr.sutterhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Amari Hospice Care IncCarmichael, CA, CCN B21648 Hospice Contracted Managing Employee (100%)
Operational/Managerial Control (100%)		 Nov 1, 2023
Nov 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1528158953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4578",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95617",
            "telephone_number": "916-646-4583",
            "fax_number": "916-646-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD",
            "address_2": "BLDG 400A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-646-4583",
            "fax_number": "916-646-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAK",
        "first_name": "ANDREW",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G78315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G783150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.