NPIMap

Organization Active NPI

Mind Body Medicine Inc

  • Psychiatry Physician
  • Stockton, CA
National Provider Identifier
1871278754
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MIND BODY MEDICINE INC
Practice address
1811 Grand Canal Blvd Ste 3
Stockton, CA 95207-8107
Phone
(209) 800-1718
NPI assigned
Jun 19, 2023
Last updated
Jun 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Authorized official

Name
Sapna Purawat, MDNPI 1437316668
Title
Owner/MD
Phone
(209) 800-1718

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

1811 Grand Canal Blvd Ste 3
Stockton, CA 95207-8107

Mailing address

1811 Grand Canal Blvd Ste 3
Stockton, CA 95207-8107
Phone (209) 800-1718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230725002706 CA Part B Supplier - Clinic/Group Practice 2264893197 Receives reassigned benefits from 11 practitioners
Practice locations: Stockton, CA

National Provider Directory

National Provider Directory

Locations

1811 Grand Canal Blvd
Ste 3
Stockton, CA 95207
Phone (209) 800-1718

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1871278754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 GRAND CANAL BLVD STE 3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952078107",
            "telephone_number": "209-800-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 GRAND CANAL BLVD STE 3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952078107",
            "telephone_number": "209-800-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "PURAWAT",
        "authorized_official_first_name": "SAPNA",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "209-800-1718",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.