NPIMap

Individual provider Active NPI

Mita Zahra Estrada Co, M.D.

  • Nephrology Physician
  • Langhorne, PA
National Provider Identifier
1851742423
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD475173 Issued in PA
Practice address
825 Town Center Dr Ste 152
Langhorne, PA 19047-1793
Phone
(215) 741-3510
Fax
(773) 665-3401
NPI assigned
Jun 24, 2016
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036155939 IL
Internal Medicine Physician 207R00000X A160905 CA
Nephrology Physician 207RN0300X 19269 ND
Nephrology Physician 207RN0300X MD475173 PA Primary

Addresses

Primary practice location

825 Town Center Dr Ste 152
Langhorne, PA 19047-1793

Mailing address

825 Town Center Dr Ste 152
Langhorne, PA 19047-1793
Phone (215) 741-3510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230509002144 MN Practitioner - NephrologyPractitioner - Internal Medicine 1153712609 Reassigns benefits to 1 organization
I20230531003054 ND Practitioner - NephrologyPractitioner - Internal Medicine 1153712609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, shared by 12 NPIs, 190 clinicians
Bridges Medical CenterGroup PAC ID 4981659851, shared by 3 NPIs, 22 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409

201 9TH St W
Ada, MN 56510-1279

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A160905CAMDInternal Medicine Physician
036155939ILMDInternal Medicine Physician
19269NDMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC CurrentSince Jun 19, 2023 Accepting new patients
Innovis Health LLC CurrentSince Jun 19, 2023 Accepting new patients
Innovis Health, LLC Current Accepting new patients
St Mary's Regional Health Center CurrentSince Jun 19, 2023 Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
St Mary's Regional Health Center CurrentSince Jun 19, 2023 Accepting new patients
Kidney and Hypertension Associates P C Nephrology Past Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

705 Pleasant Ave S
Park Rapids, MN 56470
Phone (218) 732-2800

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1851742423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 TOWN CENTER DR STE 152",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471793",
            "telephone_number": "215-741-3510",
            "fax_number": "773-665-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 TOWN CENTER DR STE 152",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471793",
            "telephone_number": "215-741-3510",
            "fax_number": "773-665-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CO",
        "first_name": "MITA ZAHRA",
        "middle_name": "ESTRADA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-24",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036155939",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A160905",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "ND",
            "license": "19269",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD475173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Langhorne, PA

Sources for this page

Verify at the official NPI Registry.