Individual provider Active NPI

Mamata Sivagnanam, MD

  • Pediatric Gastroenterology Physician
  • San Diego, CA
National Provider Identifier
1932328747
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
A86863 Issued in CA
Practice address
8110 Birmingham Way
BLDG 28
San Diego, CA 92123-2758
Phone
(858) 966-4003
Fax
(858) 560-6798
NPI assigned
Apr 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X A86863 CA Primary

Addresses

Primary practice location

8110 Birmingham Way
BLDG 28
San Diego, CA 92123-2758

Mailing address

3860 Calle Fortunada
Ste #210
San Diego, CA 92123-4802
Phone (858) 309-6303

Other names 1

  • Mamata Engineer Former name

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
I20140620002172 CA Practitioner - GastroenterologyPractitioner - Pediatric Medicine 8921192501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Pediatric Medicine
Education
University of Miami, LM Miller School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3010 Childrens Way
San Diego, CA 92123-4223
Phone (858) 576-1700

3020 Children'S Way
San Diego, CA 92123-4223
Phone (858) 576-1700

3030 Childrens Way
San Diego, CA 92123-4232
Phone (858) 576-1700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A86863CAMDPediatric Gastroenterology Physician
86863CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children'S Hospital San Diego CurrentSince Sep 1, 2009 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince Sep 1, 2009 Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Children'S Specialists of San Diego, Inc. (CSSD) Past Accepting new patients
Rady Childrens Hospital San Diego Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

3030 Childrens Way
Fl 2
San Diego, CA 92123
Phone (858) 966-5846

8110 Birmingham Way
Bldg 28
San Diego, CA 92123
Phone (858) 966-4003

3020 Childrens Way
#5030
San Diego, CA 92123
Phone (858) 966-4003

Interoperability endpoints

  • Direct secure messaging: msivagnanam12720@radychildrens.direct-ci.com

Organizations & group practices 7

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": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1932328747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "STE #210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234802",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8110 BIRMINGHAM WAY",
            "address_2": "BLDG 28",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232758",
            "telephone_number": "858-966-4003",
            "fax_number": "858-560-6798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVAGNANAM",
        "first_name": "MAMATA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "CA",
            "license": "A86863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAMATA",
            "last_name": "ENGINEER",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.