NPIMap

Individual provider Active NPI

Abhinav Koul, M.D.

  • Gastroenterology Physician
  • Sacramento, CA
National Provider Identifier
1700145661
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A147676 Issued in CA
Practice address
4150 V St Ste 3500
Sacramento, CA 95817-1460
Phone
(916) 734-7183
Fax
(916) 734-7904
NPI assigned
May 14, 2012
Last updated
Apr 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A147676 CA Primary

Addresses

Primary practice location

4150 V St Ste 3500
Sacramento, CA 95817-1460

Mailing address

4150 V St Ste 3500
Sacramento, CA 95817-1460
Phone (916) 734-7183

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
I20200706000097 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 6608182472 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Kentucky College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

500 Doyle Park Dr
Suite 205
Santa Rosa, CA 95405-4559
Phone (707) 303-8349

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy124
Upper gastrointestinal (GI) endoscopy for acid reflux723

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A147676CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca Gastroenterology CurrentSince Jul 15, 2020 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Regents of the Univ of Ca CurrentSince Jul 15, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Nov 8, 2021 Accepting new patients
Providence Medical Foundation CurrentSince Nov 8, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Kimberly Walpert, M.D., LLC Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

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

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

500 Doyle Park Dr
Ste 205
Santa Rosa, CA 95405
Phone (707) 303-8350

Interoperability endpoints

  • Direct secure messaging: akoul2028353@oc.providencedirect.org

Organizations & group practices 10

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 9

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": "1336953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1700145661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 V ST STE 3500",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171460",
            "telephone_number": "916-734-7183",
            "fax_number": "916-734-7904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 V ST STE 3500",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171460",
            "telephone_number": "916-734-7183",
            "fax_number": "916-734-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUL",
        "first_name": "ABHINAV",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-14",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A147676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.