Individual provider Active NPI

Kenneth K Tram, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Orange, CA
National Provider Identifier
1700875911
Registry record updated Feb 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
G67475 Issued in CA
Practice address
293 S Main St
Orange, CA 92868-3843
Phone
(714) 838-8848
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G67475 CA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X G67475 CA Primary

Addresses

Primary practice location

293 S Main St
Orange, CA 92868-3843

Mailing address

17360 Brookhurst St
Attn: MCMF- Credentialing Department
Fountain Valley, CA 92708-3720

Other identifiers 1

IdentifierTypeStateIssuer
00G674750MedicaidCA

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
I20040325001772 CA Practitioner - Internal Medicine 1759273659 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Geffen School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of CaliforniaGroup PAC ID 5597663641, 61 clinicians

Practice addresses (Care Compare)

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-7002

Hospital & facility affiliations

  • 24/7 Care at Home - Home Health Home health agency, Westminster, CA, CCN 059110
  • Providence at Home With Compassus Home Health Orange County Home health agency, Anaheim, CA, CCN 057600
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348
  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G67475CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents CurrentSince Jul 1, 2019 Accepting new patients
UC Regents Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Regents of the University of California Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Providence Medical Foundation Current Accepting new patients
UC Regents Current Accepting new patients
Memorialcare Medical Foundation Internal Medicine CurrentSince Oct 31, 2014 Accepting new patients
Providence Medical Foundation CurrentSince Jan 24, 2010 Accepting new patients
Providence Medical Foundation CurrentSince Jan 24, 2010 Accepting new patients
University of California Irvine Past Accepting new patients
Providence Facey Medical Foundation Past Accepting new patients
Dignity Community Care Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
University of California Irvine Past Accepting new patients
Bristol Park Medical Group, Inc Internal Medicine Past Accepting new patients
Uci Medical Group Past Accepting new patients
Talbert Medical Group, P.C. Internal Medicine Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

293 S Main St
Orange, CA 92868
Phone (714) 282-9495

293 S Main St
Ste 200
Orange, CA 92868
Phone (714) 838-8848

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

16611 Yorba Linda Blvd
Yorba Linda, CA 92886
Phone (714) 528-8670

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 5

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": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1700875911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "address_2": "ATTN: MCMF- CREDENTIALING DEPARTMENT",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683843",
            "telephone_number": "714-838-8848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAM",
        "first_name": "KENNETH",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G67475",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "G67475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G674750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.