NPIMap

Individual provider Active NPI

Dean Matthew Kelaita, M.D.

  • Family Medicine Physician
  • San Andreas, CA
National Provider Identifier
1750310496
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G80069 Issued in CA
Practice address
702 Mountain Ranch Rd.
San Andreas, CA 95249
Phone
(209) 754-0870
Fax
(209) 754-0878
NPI assigned
Jul 3, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 G80069 CA Primary

Addresses

Primary practice location

702 Mountain Ranch Rd.
San Andreas, CA 95249

Mailing address

P.O. Box 636
San Andreas, CA 95249
Phone (209) 754-0870

Other identifiers 1

IdentifierTypeStateIssuer
00G800690MedicaidCA

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
I20040625000955 CA Practitioner - Family PracticePractitioner - Internal Medicine 5092791541 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark Twain Medical CenterGroup PAC ID 8820073711, 27 clinicians

Practice addresses (Care Compare)

2182 Hwy 4
Suite A100
Arnold, CA 95223-7281
Phone (209) 754-9232

590 Stanislaus Ave
Angels Camp, CA 95222-9355
Phone (209) 736-0813

768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Phone (209) 754-3521

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G80069CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Mar 8, 2021 Accepting new patients
Dean M Kelaita M D Medical CurrentSince Sep 1, 2021 Accepting new patients
Sonora Community Hospital CurrentSince Feb 11, 2017 Accepting new patients
Sonora Community Hospital Family Medicine CurrentSince Feb 11, 2017 Accepting new patients
Mark Twain Medical Center Past Accepting new patients
County of Calaveras Past Accepting new patients
Sonora Community Hospital Past Accepting new patients
County of Calaveras Past Accepting new patients

Locations

702 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 754-0870

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

900 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 419-0956

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Golden San Andreas Care CenterSan Andreas, CA, CCN 056132 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2023
Mar 1, 2023
Family Medical Center-CopperopolisCopperopolis, CA, CCN 058548 Rural health clinic Corporate Director Jan 7, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1750310496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 636",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-754-0870",
            "fax_number": "209-754-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 MOUNTAIN RANCH RD.",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-754-0870",
            "fax_number": "209-754-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELAITA",
        "first_name": "DEAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G80069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G800690",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.