Jagannath Sam Nayak

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A166879 Issued in CA

Practice address

400 N Pepper Ave
Colton, CA 92324-1819

Phone

(909) 580-2186

NPI assigned

Mar 21, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of California, San Diego School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Heritage Medical Group IncGroup PAC ID 7517284029, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospital of San Bernardino Hospital, San Bernardino, CA, CCN 050089

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Pacific Heritage Medical Group Inc

  • Geriatric Psychiatry Physician
  • Westlake Village, CA
  • NPI 1467899450
  Medicare reassignment Care Compare group NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Santa Maria, CA
  • NPI 1538757232
  Medicare reassignment NPD
• Asana Integrated Medical Group PC

  • Psychiatry Physician
  • Sioux Falls, SD
  • NPI 1396783379

  CA

  Medicare reassignment NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Indio, CA
  • NPI 1144195926
  NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Colton, CA
  • NPI 1306408000
  NPD

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

• Community Hospital of San Bernardino

  • General Acute Care Hospital
  • San Bernardino, CA
  • NPI 1235290818
  Care Compare affiliation

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1548764863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241819",
            "telephone_number": "909-580-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241819",
            "telephone_number": "909-580-2186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1805 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924111217",
            "country_code": "US",
            "telephone_number": "844-496-9160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAYAK",
        "first_name": "JAGANNATH",
        "middle_name": "SAM",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2023-10-17",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A166879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Namsang, SLP
• Shyamlee Nanda
• Keisha Renette Nanfang-Williams, RN
• National Vision, Inc.
• Itzel Guadalupe Navarro Ordaz
• Shahid Nazir, MD
• Johannes Charles Ndlela, M.D.
• Michael Neeki, DO
• Laura A Negin
• Amber Nelson-Thorneycroft

• Psychiatry Physician in Colton, CA
• Providers in Colton, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.