Individual provider Active NPI

Kaitlin Lee Shruhan, RD

  • Registered Dietitian
  • Palo Alto, CA
National Provider Identifier
1770060642
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86058052 Issued in CA
Practice address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone
(650) 497-8000
NPI assigned
Jul 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86058052 CA Primary

Addresses

Primary practice location

725 Welch Rd
Palo Alto, CA 94304-1601

Mailing address

725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000

Other practice location 1

3600 Broadway
Oakland, CA 94611-5730
Phone (510) 752-1000

Other practice location 2

3600 Broadway
Oakland, CA 94611-5730
Phone (510) 752-1000

Other names 1

  • Kaitlin Lee Barragan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240304003803 MA Practitioner - Registered Dietitian Or Nutrition Professional 2062886955 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86058052CAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc CurrentSince Feb 13, 2024 Accepting new patients
The General Hospital Corporation CurrentSince Feb 13, 2024 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

62 13th St
Ste 102
Charlestown, MA 02129

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1770060642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Broadway",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946115730",
            "country_code": "US",
            "telephone_number": "510-752-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 Broadway",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946115730",
            "country_code": "US",
            "telephone_number": "510-752-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHRUHAN",
        "first_name": "KAITLIN",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-24",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86058052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "BARRAGAN",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.