Individual provider Active NPI

Laura Margaret Kester Prakash, MD

  • Pediatric Adolescent Medicine Physician
  • Sacramento, CA
National Provider Identifier
1639372170
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
01070009A Issued in IN
Practice address
2516 Stockton Blvd
Sacramento, CA 95817-2208
Phone
(916) 734-5387
Fax
(916) 456-2236
NPI assigned
Jun 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C145145 CA
Pediatric Adolescent Medicine Physician 2080A0000X 01070009A IN Primary

Addresses

Primary practice location

2516 Stockton Blvd
Sacramento, CA 95817-2208

Mailing address

2516 Stockton Blvd
Sacramento, CA 95817-2208
Phone (916) 734-5387

Other identifiers 1

IdentifierTypeStateIssuer
201107230MedicaidIN

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
I20161111001905 CA Practitioner - Pediatric Medicine 9133368996 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C145145CAMDPediatrics Physician
01070009AINMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Sacramento CurrentSince Aug 20, 2017 Accepting new patients
County of Sacramento CurrentSince Aug 20, 2017 Accepting new patients
Regents of the Univ of Ca CurrentSince Nov 1, 2016 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca CurrentSince Nov 1, 2016 Accepting new patients
The Health and Hospital Corporation of Marion County Past Accepting new patients
Major Hospital Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

4600 Broadway
#1100
Sacramento, CA 95820
Phone (916) 874-9670

2521 Stockton Blvd
Ste 2200
Sacramento, CA 95817
Phone (916) 734-1180

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

4600 Broadway
Sacramento, CA 95820
Phone (916) 874-9670

Interoperability endpoints

  • Direct secure messaging: lkester213062@direct.ochin.org

Organizations & group practices 9

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": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1639372170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-5387",
            "fax_number": "916-456-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-5387",
            "fax_number": "916-456-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRAKASH",
        "first_name": "LAURA",
        "middle_name": "MARGARET KESTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C145145",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IN",
            "license": "01070009A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201107230",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.