NPIMap

Individual provider Active NPI

Jiten Prakash Mehta, D0

  • Nephrology Physician
  • Orange, CA
National Provider Identifier
1861912289
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
17684 Issued in CA
Practice address
1310 W Stewart Dr Ste 210
Orange, CA 92868-3837
Phone
(714) 836-4204
NPI assigned
Jun 27, 2017
Last updated
Jul 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 17684 CA Primary

Addresses

Primary practice location

1310 W Stewart Dr Ste 210
Orange, CA 92868-3837

Mailing address

12665 Garden Grove Blvd Ste 211
Garden Grove, CA 92843-1916
Phone (714) 636-2890

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220825001563 CA Practitioner - Nephrology 9234513284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Midwestern University, Chicago College of Osteopathic Med, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Kidney Consultants IncGroup PAC ID 6103811286, 21 clinicians

Practice addresses (Care Compare)

12665 Garden Grove Blvd
Suite 211
Garden Grove, CA 92843-1916
Phone (714) 636-2890

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17648CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Kidney Consultants Inc. Nephrology CurrentSince Jul 25, 2022 Accepting new patients
Nephrology Consultants Medical Office Inc Nephrology PastSince Jul 24, 2022 Accepting new patients

Locations

100 E Valencia Mesa Dr
Ste 100
Fullerton, CA 92835
Phone (714) 525-4185

12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843
Phone (714) 636-2890

1310 W Stewart Dr
Ste 210
Orange, CA 92868
Phone (714) 288-9229

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21072/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jiten.mehta.1@21072.direct.athenahealth.com

Organizations & group practices 2

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 11

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": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1861912289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 211",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-636-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W STEWART DR STE 210",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683837",
            "telephone_number": "714-836-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "JITEN",
        "middle_name": "PRAKASH",
        "name_prefix": "Dr.",
        "credential": "D0",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "17684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.