Individual provider Active NPI

My Phuong Nguyen Mitarai, M.D.

  • Emergency Medicine Physician
  • San Jose, CA
National Provider Identifier
1639285984
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
521403415 Issued in MD
Practice address
751 S Bascom Ave
San Jose, CA 95128-2604
Phone
(408) 885-6990
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A97854 CA
Emergency Medicine Physician 207P00000X 521403415 MD Primary

Addresses

Primary practice location

751 S Bascom Ave
San Jose, CA 95128-2604

Mailing address

1021 W Iowa Ave
Sunnyvale, CA 94086-7403
Phone (408) 732-7691

Other identifiers 1

IdentifierTypeStateIssuer
410852300MedicaidMD

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080116000747 CA Practitioner - Emergency Medicine 9032119177 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
97854CAMDMarriage & Family Therapist
A97854CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Jun 17, 2015 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara Emergency Medicine CurrentSince Jun 17, 2015 Accepting new patients
Cep America - California Emergency Medicine CurrentSince May 26, 2015 Accepting new patients
Cep America-California Emergency Medicine CurrentSince May 26, 2015 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

Organizations & group practices 6

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1639285984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W IOWA AVE",
            "city": "SUNNYVALE",
            "state": "CA",
            "postal_code": "940867403",
            "telephone_number": "408-732-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 S BASCOM AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282604",
            "telephone_number": "408-885-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITARAI",
        "first_name": "MY PHUONG",
        "middle_name": "NGUYEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A97854",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "521403415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410852300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.