Individual provider Active NPI

Manpreet Kaur

  • Physician Assistant
  • Roseville, CA
National Provider Identifier
1811650385
Registry record updated Jun 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60555 Issued in CA
Practice address
1528 Eureka Rd Ste 103
Roseville, CA 95661-3047
Phone
(916) 772-5325
NPI assigned
Oct 20, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA60555 CA Primary

Addresses

Primary practice location

1528 Eureka Rd Ste 103
Roseville, CA 95661-3047

Mailing address

6304 Smith Ave
Newark, CA 94560-4543

Other practice location 1

6304 Smith Ave
Newark, CA 94560-4543
Phone (510) 676-9872

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240424000813 CA Practitioner - Physician Assistant 2860831856 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
60555CAMDGeneral Practice Dentistry
PA60555CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spine & Nerve Diagnostic Center CurrentSince May 28, 2024 Accepting new patients
Spine & Nerve Diagnostic Center CurrentSince May 28, 2024 Accepting new patients

Locations

1528 Eureka Rd
Ste 103
Roseville, CA 95661
Phone (916) 772-5325

Interoperability endpoints

  • Direct secure messaging: mkaur682025@hisp.ehr.sutterhealth.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717286400000",
    "number": "1811650385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6304 SMITH AVE",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945604543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 EUREKA RD STE 103",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613047",
            "telephone_number": "916-772-5325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6304 Smith Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "CA",
            "postal_code": "945604543",
            "country_code": "US",
            "telephone_number": "510-676-9872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAUR",
        "first_name": "MANPREET",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2024-06-02",
        "certification_date": "2024-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.