Individual provider Active NPI

Samudyatha Shivalingappa, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Sunnyvale, CA
National Provider Identifier
1841286960
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
A97567 Issued in CA
Practice address
582 S Sunnyvale Ave
Sunnyvale, CA 94086-6125
Phone
(408) 524-4116
NPI assigned
Sep 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD23979 OR
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD23979 OR
Endocrinology, Diabetes & Metabolism Physician 207RE0101X A97567 CA Primary

Addresses

Primary practice location

582 S Sunnyvale Ave
Sunnyvale, CA 94086-6125

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408

Other identifiers 1

IdentifierTypeStateIssuer
117023MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040512000005 OR Practitioner - Internal MedicinePractitioner - Geriatric Medicine 1557350741 Reassigns benefits to 1 organization
I20240403003932 CA Practitioner - Internal Medicine 1557350741 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

1950 University Ave
Suite 160
East Palo Alto, CA 94303-2285
Phone (650) 317-8100

370 Distel Cir
Los Altos, CA 94022-1404
Phone (650) 254-5200

582 S Sunnyvale Ave
Sunnyvale, CA 94086-6125
Phone (408) 733-4380

851 Cherry Ave
Suite 4
San Bruno, CA 94066-2953
Phone (800) 972-5547

Merit-based Incentive Payment System (MIPS)

Final score
89.05 of 100Reported as group
Quality
87.64
Promoting interoperability
100
Improvement activities
40
Cost
73.33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A97567CAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Oct 7, 2024 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 7, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Dec 21, 2009 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 18, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 18, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Dec 21, 2009 Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

350 John Muir Pkwy
Ste 160
Brentwood, CA 94513
Phone (925) 204-1920

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
#1112
Palo Alto, CA 94301

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 780-0110

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

582 S Sunnyvale Ave
Sunnyvale, CA 94086
Phone (408) 523-3060

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Interoperability endpoints

  • Direct secure messaging: sshivalingappa694607@hisp.ehr.sutterhealth.org

Organizations & group practices 8

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1841286960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "582 S SUNNYVALE AVE",
            "city": "SUNNYVALE",
            "state": "CA",
            "postal_code": "940866125",
            "telephone_number": "408-524-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVALINGAPPA",
        "first_name": "SAMUDYATHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23979",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD23979",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "A97567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117023",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sunnyvale, CA

Sources for this page

Verify at the official NPI Registry.