Individual provider Active NPI

Ketan Bakriwala, O.D.

  • Optometrist
  • Chula Vista, CA
National Provider Identifier
1528355872
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14277 TGL Issued in CA
Practice address
342 F St
Chula Vista, CA 91910-2625
Phone
(619) 422-1471
Fax
(619) 422-0114
NPI assigned
Jul 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG002482 PA
Optometrist 152W00000X 14277 TGL CA Primary

Addresses

Primary practice location

342 F St
Chula Vista, CA 91910-2625

Mailing address

342 F St
Chula Vista, CA 91910-2625
Phone (619) 422-1471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130802000722 CA Practitioner - Optometry 3072754068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

1400 E Palomar St
Chula Vista, CA 91913-1800
Phone (858) 499-2600

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
81.04
Promoting interoperability
99
Improvement activities
40
Cost
82.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14277CAMDAddiction (Substance Use Disorder) Counselor
14277 TGLCAMDOptometrist
OEG002482PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Optometrist CurrentSince Feb 15, 2019 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Optometrist CurrentSince Feb 15, 2019 Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients

Locations

1400 E Palomar St
Chula Vista, CA 91913
Phone (619) 397-3077

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

8701 Cuyamaca St
Santee, CA 92071
Phone (619) 568-8025

Interoperability endpoints

  • Direct secure messaging: kbakriwala34134@sharphealthcare.direct-ci.com

Organizations & group practices 5

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": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439251200000",
    "number": "1528355872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 F ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102625",
            "telephone_number": "619-422-1471",
            "fax_number": "619-422-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 F ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102625",
            "telephone_number": "619-422-1471",
            "fax_number": "619-422-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKRIWALA",
        "first_name": "KETAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-07",
        "last_updated": "2015-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002482",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14277 TGL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.