Individual provider Active NPI

Pavan K Madan, M.D.

  • Psychiatry Physician
  • Davis, CA
National Provider Identifier
1922319573
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
134176 Issued in CA
Practice address
1712 Picasso Ave Ste D
Davis, CA 95618-0546
Phone
(530) 297-7500
Fax
(530) 297-7751
NPI assigned
Jun 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 134176 CA
Psychiatry Physician 2084P0800X 134176 CA Primary

Addresses

Primary practice location

1712 Picasso Ave Ste D
Davis, CA 95618-0546

Mailing address

3835 N Freeway Blvd Ste 100
Sacramento, CA 95834-1954
Phone (916) 576-7900

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
I20150910002681 CA Practitioner - Psychiatry 8325355134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1590 Drew Ave
Suite 200
Davis, CA 95618-7848
Phone (530) 297-7500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
134176CAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark David Levine MD, Professional Corporation Psychiatry CurrentSince Oct 1, 2017 Accepting new patients
Mark David Levine, MD Burlingame PC Psychiatry CurrentSince Oct 1, 2017 Accepting new patients
Mark David Levine M.D. Professional Corporation Psychiatry Current Accepting new patients
Mark David Levinem MD Sunnyvale PC Psychiatry Past Accepting new patients

Locations

1712 Picasso Ave
Ste D
Davis, CA 95618
Phone (530) 297-7500

1590 Drew Ave
Ste 200
Davis, CA 95618
Phone (530) 297-7500

5100 N 6th St
Ste 135
Fresno, CA 93710
Phone (559) 490-2067

3501 Coffee Rd
Ste 7
Modesto, CA 95355
Phone (209) 676-3069

3835 N Freeway Blvd
Ste 100
Sacramento, CA 95834
Phone (916) 576-7898

999 Baker Way
Ste 420
San Mateo, CA 94404
Phone (650) 571-9652

Organizations & group practices 4

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": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522195200000",
    "number": "1922319573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3835 N FREEWAY BLVD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341954",
            "telephone_number": "916-576-7900",
            "fax_number": "916-285-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 PICASSO AVE STE D",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956180546",
            "telephone_number": "530-297-7500",
            "fax_number": "530-297-7751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADAN",
        "first_name": "PAVAN",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2018-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "134176",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "134176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

Verify at the official NPI Registry.