Individual provider Active NPI

Dhriti Mukhopadhyay, M.D.

  • Surgery Physician
  • Tuba City, AZ
National Provider Identifier
1639490725
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
BP10037252 Issued in TX
Practice address
167 N Main St
Tuba City, AZ 86045-0600
Phone
(928) 283-2501
NPI assigned
Jun 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X BP10037252 TX Primary

Addresses

Primary practice location

167 N Main St
Tuba City, AZ 86045-0600

Mailing address

PO Box 600
Tuba City, AZ 86045-0600
Phone (928) 283-2501

Other identifiers 2

IdentifierTypeStateIssuer
361795MedicaidAZ
550121OtherTXPIT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WA, OR3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20180308000826 TX Practitioner - General Surgery 3476834631 Reassigns benefits to 1 organization
I20230120002764 WA Practitioner - General Surgery 3476834631 Reassigns benefits to 1 organization
I20230123002955 OR Practitioner - General Surgery 3476834631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5125 Skyline Rd S
Salem, OR 97306-9427
Phone (800) 813-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10037252TXMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Surgery CurrentSince Jan 23, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Surgery CurrentSince Jan 23, 2023 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Jan 31, 2018 Accepting new patients
Tuba City Regional Health Care Corporation Surgery CurrentSince Jan 31, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Surgery Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jan 23, 2023 Accepting new patients
Salem Health Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

5125 Skyline Rd S
Salem, OR 97306
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1276387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1639490725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKHOPADHYAY",
        "first_name": "DHRITI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-13",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "BP10037252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "361795",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIT",
            "identifier": "550121",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuba City, AZ

Sources for this page

Verify at the official NPI Registry.