Individual provider Active NPI

Mohammad Anoosh Malaekeh, MD

  • Pediatrics Physician
  • Roseville, CA
National Provider Identifier
1821071143
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G77242 Issued in CA
Practice address
2261 Douglas Blvd
Roseville, CA 95661-3831
Phone
(916) 783-7109
Fax
(916) 773-3405
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G77242 CA Primary

Addresses

Primary practice location

2261 Douglas Blvd
Roseville, CA 95661-3831

Mailing address

2261 Douglas Blvd
Roseville, CA 95661-3831
Phone (916) 783-7109

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
I20240726001925 CA Practitioner - Pediatric Medicine 4284170119 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G77242CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince May 2, 2024 Accepting new patients
Regents of the University of California CurrentSince May 2, 2024 Accepting new patients
Dignity Health Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Essent PRMC LP Past Accepting new patients

Locations

10850 White Rock Rd
Rancho Cordova, CA 95670

2261 Douglas Blvd
Roseville, CA 95661
Phone (916) 783-1044

1620 E Roseville Pkwy
Ste 200
Roseville, CA 95661
Phone (916) 771-0251

Organizations & group practices 6

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": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196380800000",
    "number": "1821071143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2261 DOUGLAS BLVD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613831",
            "telephone_number": "916-783-7109",
            "fax_number": "916-773-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2261 DOUGLAS BLVD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613831",
            "telephone_number": "916-783-7109",
            "fax_number": "916-773-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAEKEH",
        "first_name": "MOHAMMAD",
        "middle_name": "ANOOSH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2007-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G77242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.