NPIMap

Individual provider Active NPI

Surindra N Mitruka, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Santa Cruz, CA
National Provider Identifier
1861590382
Registry record updated Apr 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
G84058 Issued in CA
Practice address
1575 Soquel Dr
Suite C
Santa Cruz, CA 95065-1700
Phone
(831) 458-6288
Fax
(831) 477-9026
NPI assigned
Sep 20, 2006
Last updated
Apr 27, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X G84058 CA Primary

Addresses

Primary practice location

1575 Soquel Dr
Suite C
Santa Cruz, CA 95065-1700

Mailing address

2025 Soquel Ave
Santa Cruz, CA 95062-1323
Phone (831) 458-6603

Other identifiers 1

IdentifierTypeStateIssuer
00G840580MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Eisenhower Medical Center Past Accepting new patients
Scripps Health Past Accepting new patients
Palomar Health Past Accepting new patients
JFK Memorial Hospital, Inc. Past Accepting new patients
Advanced Vein Therapeutics PastSince Jul 1, 2006 Accepting new patients
Sutter Bay Medical Foundation Past Accepting new patients
Tri-City Hospital Past Accepting new patients

Organizations & group practices 7

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335484800000",
    "number": "1861590382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 SOQUEL AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621323",
            "telephone_number": "831-458-6603",
            "fax_number": "831-458-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 SOQUEL DR",
            "address_2": "SUITE C",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651700",
            "telephone_number": "831-458-6288",
            "fax_number": "831-477-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRUKA",
        "first_name": "SURINDRA",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G84058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G840580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.