Individual provider Active NPI

Kathleen Trivich, M.D.

  • Internal Medicine Physician
  • Anaheim, CA
National Provider Identifier
1871534552
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
43731 Issued in CA
Practice address
631 S Brookhurst St Ste 101
Anaheim, CA 92804-3563
Phone
(714) 991-5700
Fax
(714) 991-5800
NPI assigned
Jun 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G43731 CA
Internal Medicine Physician 207R00000X 43731 CA Primary

Addresses

Primary practice location

631 S Brookhurst St Ste 101
Anaheim, CA 92804-3563

Mailing address

631 S Brookhurst St Ste 101
Anaheim, CA 92804-3563
Phone (714) 991-5700

Other identifiers 1

IdentifierTypeStateIssuer
00A49450MedicaidCA

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

State licenses

LicenseStateTypeSpecialty
43731CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Emergency Medical Associates, Inc PastSince May 25, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1871534552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S BROOKHURST ST STE 101",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043563",
            "telephone_number": "714-991-5700",
            "fax_number": "714-991-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S BROOKHURST ST STE 101",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043563",
            "telephone_number": "714-991-5700",
            "fax_number": "714-991-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIVICH",
        "first_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G43731",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "43731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A49450",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; 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.