Active NPI
Pushpa Dewanimal Jagtiani, MD.
- Internal Medicine Physician
- Fremont, CA
National Provider Identifier
1811243892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- AFE29717
- Practice address
- 702 Patriot Place
Fremont, CA 94539 - Phone
- (510) 770-0432
- NPI assigned
- Jul 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | AFE29717 | CA | Primary |
Addresses
Primary practice location
702 Patriot Place
Fremont, CA 94539
Mailing address
702 Patriot Place
Fremont, CA 94539
Phone (510) 770-0432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AFE29717 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343347200000",
"number": "1811243892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 PATRIOT PLACE",
"city": "FREMONT",
"state": "CA",
"postal_code": "94539",
"telephone_number": "510-770-0432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 PATRIOT PLACE",
"city": "FREMONT",
"state": "CA",
"postal_code": "94539",
"telephone_number": "510-770-0432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAGTIANI",
"first_name": "PUSHPA",
"middle_name": "DEWANIMAL",
"name_prefix": "Dr.",
"credential": "MD.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-27",
"last_updated": "2012-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "AFE29717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.