Individual provider Active NPI

Gayathri Devi Kalva, M.D.

  • Internal Medicine Physician
  • Lodi, CA
National Provider Identifier
1851755185
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
T4864 Issued in TX
Practice address
999 S Fairmont Ave Ste 130
Lodi, CA 95240-5141
Phone
(209) 366-2001
NPI assigned
Apr 13, 2016
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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 A167751 CA
Internal Medicine Physician 207R00000X D62165 MD
Internal Medicine Physician 207R00000X T4864 TX Primary

Addresses

Primary practice location

999 S Fairmont Ave Ste 130
Lodi, CA 95240-5141

Mailing address

PO Box 255228
Sacramento, CA 95865-5228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20211104002419 TX Practitioner - Internal Medicine 6901221126 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lonestar Pat Associates PAGroup PAC ID 9335559871, 24 clinicians
Ipc Healthcare Services of Texas PLLCGroup PAC ID 3971824939, 184 clinicians

Practice addresses (Care Compare)

12221 N Mopac Expy
Austin, TX 78758-2401
Phone (512) 901-1000

2000 Scenic Dr
Georgetown, TX 78626-7726
Phone (512) 942-4146

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A167751CAMDInternal Medicine Physician
T4864TXMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lonestar Pat Associates PA Internal Medicine CurrentSince Jan 1, 2024 Accepting new patients
Ipc Healthcare Services of Texas, PLLC Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
St Davids Healthcare Partnership LP LLP Past Accepting new patients

Locations

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

901 W Ben White Blvd
Austin, TX 78704
Phone (512) 342-2382

2000 Scenic Dr
Georgetown, TX 78626
Phone (512) 863-2117

2400 Round Rock Ave
Round Rock, TX 78681
Phone (512) 255-6066

111 Dallas St
San Antonio, TX 78205
Phone (210) 297-7000

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.

Hospital & facility affiliations 1

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": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1851755185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE STE 130",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405141",
            "telephone_number": "209-366-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALVA",
        "first_name": "GAYATHRI DEVI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A167751",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D62165",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "T4864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.