Individual provider Active NPI

Prital Desai

  • Psychiatry Physician
  • Santa Rosa, CA
National Provider Identifier
1801224092
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A150768 Issued in CA
Practice address
480 Tesconi Cir Ste B
Santa Rosa, CA 95401
Phone
(707) 206-7268
Fax
(707) 206-7254
NPI assigned
Oct 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A150769 CA
Psychiatry Physician 2084P0800X A150768 CA Primary

Addresses

Primary practice location

480 Tesconi Cir Ste B
Santa Rosa, CA 95401

Mailing address

480 Tesconi Cir Ste B
Santa Rosa, CA 95401-4691
Phone (707) 206-7268

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
I20180510001389 CA Practitioner - Psychiatry 4688938020 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mark David Levine MD Professional CorporationGroup PAC ID 0143478305, 165 clinicians

Practice addresses (Care Compare)

141 Stony Cir
Suite 155
Santa Rosa, CA 95401-4172
Phone (855) 601-1004

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A150769CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark David Levine M.D. Professional Corporation Psychiatry CurrentSince Jul 15, 2023 Accepting new patients
Mark David Levine, MD Burlingame PC Psychiatry CurrentSince Jul 15, 2023 Accepting new patients
Mark David Levinem MD Sunnyvale PC Psychiatry CurrentSince Jul 15, 2023 Accepting new patients
Siyan Clinical Corporation Psychiatry CurrentSince Mar 31, 2018 Accepting new patients

Locations

3835 N Freeway Blvd
Ste 100
Sacramento, CA 95834
Phone (916) 576-7898

1900 The Alameda
Ste 200
San Jose, CA 95126

1922 The Alameda
Ste 440
San Jose, CA 95126
Phone (408) 400-0333

141 Stony Cir
Ste 155
Santa Rosa, CA 95401
Phone (707) 341-5117

480 Tesconi Cir
Ste B
Santa Rosa, CA 95401
Phone (707) 206-7268

1287 Fulton Rd
Santa Rosa, CA 95401
Phone (707) 543-2031

333 W El Camino Real
Ste 280
Sunnyvale, CA 94087
Phone (669) 201-3177

Organizations & group practices 4

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": "1382572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1801224092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 TESCONI CIR STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014691",
            "telephone_number": "707-206-7268",
            "fax_number": "707-206-7254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 TESCONI CIR STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95401",
            "telephone_number": "707-206-7268",
            "fax_number": "707-206-7254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "PRITAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-24",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A150769",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A150768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.