NPIMap

Individual provider Active NPI

Kuntal M Thaker, MD

  • Gastroenterology Physician
  • Santa Cruz, CA
National Provider Identifier
1952369191
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E-4883 Issued in AR
Practice address
2850 Commercial Crossing
Santa Cruz, CA 95065-1702
Phone
(831) 460-7350
Fax
(831) 460-7351
NPI assigned
May 3, 2006
Last updated
Sep 18, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X E-4883 AR Primary

Addresses

Primary practice location

2850 Commercial Crossing
Santa Cruz, CA 95065-1702

Mailing address

2025 Soquel Ave.
Santa Cruz, CA 95062-1323

Other identifiers 1

IdentifierTypeStateIssuer
161442001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121022000386 CA Practitioner - Gastroenterology 6901819291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of California, Geffen School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

370 Distel Cir
Los Altos, CA 94022-1404
Phone (650) 254-5200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy148
Upper gastrointestinal (GI) endoscopy for acid reflux185

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4883ARMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 27, 2012 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Aug 27, 2012 Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients
Jefferson University Physicians Past Accepting new patients
Dignity Health Past Accepting new patients
Pajaro Valley Health Care District Hospital Corporation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Mercy Health Northwest Arkansas Communities PastSince Jan 1, 1990 Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients

Locations

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

290 Redwood Shores Pkwy
Redwood City, CA 94065
Phone (650) 598-3160

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

1662 Dominican Way
Santa Cruz, CA 95065
Phone (408) 475-1100

2025 Soquel Ave
Santa Cruz, CA 95062
Phone (408) 423-4111

2850 Commercial Xing
Santa Cruz, CA 95065
Phone (831) 458-5511

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: kthaker130046@hisp.ehr.sutterhealth.org

Organizations & group practices 9

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1952369191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 SOQUEL AVE.",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 COMMERCIAL CROSSING",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651702",
            "telephone_number": "831-460-7350",
            "fax_number": "831-460-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKER",
        "first_name": "KUNTAL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E-4883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161442001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.