NPIMap

Individual provider Active NPI

Curtis Kiyoshi Kodama, D.O.

  • Family Medicine Physician
  • Moorpark, CA
National Provider Identifier
1679560973
Registry record updated Nov 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A6143 Issued in CA
Practice address
865 Patriot Dr Ste 101
Moorpark, CA 93021-3407
Phone
(805) 532-2032
Fax
(805) 532-2844
NPI assigned
Oct 1, 2005
Last updated
Nov 14, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A6143 CA Primary

Addresses

Primary practice location

865 Patriot Dr Ste 101
Moorpark, CA 93021-3407

Mailing address

865 Patriot Dr Ste 101
Moorpark, CA 93021-3407
Phone (805) 532-2032

Other identifiers 1

IdentifierTypeStateIssuer
00AX61430MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050715001101 CA Practitioner - Family Practice 4688600026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr. Curtis Kodama and Associates, Inc.Group PAC ID 2365620440, 2 clinicians

Practice addresses (Care Compare)

865 Patriot Dr
Suite 101
Moorpark, CA 93021-3407
Phone (805) 532-2032

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions14
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A6143CAMDFamily Medicine Physician
6143CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Curtis Kodama & Associates, Inc. Family Medicine CurrentSince May 2, 2011 Accepting new patients
Simi Valley Hospital and Health Care Services Past Accepting new patients

Locations

865 Patriot Dr
Ste 101
Moorpark, CA 93021
Phone (805) 532-2032

865 Patriot Dr
Ste 102
Moorpark, CA 93021
Phone (805) 532-2032

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1128124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384387200000",
    "number": "1679560973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 PATRIOT DR STE 101",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930213407",
            "telephone_number": "805-532-2032",
            "fax_number": "805-532-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 PATRIOT DR STE 101",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930213407",
            "telephone_number": "805-532-2032",
            "fax_number": "805-532-2844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODAMA",
        "first_name": "CURTIS",
        "middle_name": "KIYOSHI",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-01",
        "last_updated": "2013-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX61430",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorpark, CA

Sources for this page

Verify at the official NPI Registry.