Individual provider Active NPI

Praveena Gopinatha Mallya, DO

  • Pediatrics Physician
  • Palo Alto, CA
National Provider Identifier
1922020635
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2OA12814 Issued in CA
Practice address
795 El Camino Real
Palo Alto, CA 94302-2302
Phone
(650) 853-6558
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X OS013741 PA
Pediatrics Physician 208000000X 2OA12814 CA Primary

Addresses

Primary practice location

795 El Camino Real
Palo Alto, CA 94302-2302

Mailing address

2350 W. El Camino Real
2ND Floor
Mountain View, CA 94040-6203

Other identifiers 1

IdentifierTypeStateIssuer
0219525MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160527000660 CA Practitioner - Pediatric Medicine 7416954409 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.01 of 100Reported as group
Quality
86.78
Improvement activities
40
Cost
70.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2OA12814CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UCSF Medical Group Business Services CurrentSince Dec 19, 2022 Accepting new patients
University of California San Francisco Pediatrics CurrentSince Dec 19, 2022 Accepting new patients
University of California San Francisco CurrentSince Dec 19, 2022 Accepting new patients
UCSF Medical Group Business Services CurrentSince Dec 19, 2022 Accepting new patients
UCSF Health Medical Foundation Past Accepting new patients

Locations

3100 San Pablo Ave
Berkeley, CA 94702
Phone (510) 985-5020

225 California Dr
Burlingame, CA 94010
Phone (415) 353-2002

325 Gellert Blvd
Daly City, CA 94015
Phone (650) 270-2394

6475 Christie Ave
Ste 300
Emeryville, CA 94608
Phone (415) 476-7220

747 52nd St
Oakland, CA 94609
Phone (510) 428-3070

3900 Piedmont Ave
Piedmont, CA 94611
Phone (415) 432-7899

830 Jefferson Ave
Ste M
Redwood City, CA 94063
Phone (650) 381-0616

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

1199 Bush St
Ste 400
San Francisco, CA 94109
Phone (415) 379-2980

521 Parnassus Ave
Fl 7
San Francisco, CA 94143
Phone (415) 353-1238

2001 The Embarcadero
Ofc Of
San Francisco, CA 94143
Phone (628) 224-5503

3838 California St
Rm 200
San Francisco, CA 94118

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: praveena.mallya@guc.eclinicaldirectplus.com
  • Direct secure messaging: pmallya130908@direct-ucsfmedicalcenter.org

Organizations & group practices 5

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1922020635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 W. EL CAMINO REAL",
            "address_2": "2ND FLOOR",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940406203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 EL CAMINO REAL",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943022302",
            "telephone_number": "650-853-6558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLYA",
        "first_name": "PRAVEENA",
        "middle_name": "GOPINATHA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS013741",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "2OA12814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0219525",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.