NPIMap

Individual provider Active NPI

Dennis Nakata, M.D.

  • Family Medicine Physician
  • Clovis, CA
National Provider Identifier
1962483834
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G34989 Issued in CA
Practice address
275 W Herndon Ave
Clovis, CA 93612-0204
Phone
(559) 324-6200
Fax
(559) 324-6280
NPI assigned
Nov 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G34989 CA Primary

Addresses

Primary practice location

275 W Herndon Ave
Clovis, CA 93612-0204

Mailing address

PO Box 28949
Fresno, CA 93729-8949
Phone (559) 228-4200

Other identifiers 4

IdentifierTypeStateIssuer
00G349890OtherCABLUE CROSS/BLUE SHIELD
77040368493612B021OtherCACHAMPUS
00G349890MedicaidCA
110125079OtherCARAILROAD MEDICARE

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
I20080617000718 CA Practitioner - Family Practice 5799856894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Francisco School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Foundation Medical GroupGroup PAC ID 0345406294, 282 clinicians

Practice addresses (Care Compare)

275 W Herndon Ave
Clovis, CA 93612-0204
Phone (559) 324-6200

Hospital & facility affiliations

  • Omnia Healthcare, LLC Home health agency, Clovis, CA, CCN 059683
  • Clovis Community Medical Center Hospital, Clovis, CA, CCN 050492
  • Saint Agnes Medical Center Hospital, Fresno, CA, CCN 050093

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34989CAMDSocial Worker
G34989CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Apr 1, 2014 Accepting new patients
Community Foundation Medical Group Current Accepting new patients
Community Foundation Medical Group CurrentSince Apr 1, 2014 Accepting new patients
Hanford Community Hospital Past Accepting new patients
Valley Children'S Hospital Past Accepting new patients
Bakersfield Memorial Hospital Past Accepting new patients

Locations

275 W Herndon Ave
Clovis, CA 93612
Phone (559) 321-4255

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1962483834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28949",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937298949",
            "telephone_number": "559-228-4200",
            "fax_number": "559-224-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKATA",
        "first_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G34989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00G349890",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "77040368493612B021",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G349890",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110125079",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.