Reza Bayati, MD
Individual provider Active NPI Internal Medicine Physician · Roseville, CA
NPI 1962584920 · NPPES record last updated Dec 22, 2016
Key facts
- NPI
- 1962584920
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- C52426 (CA)
- Practice address
- 1 Medical Plaza Dr
Wound Care Clinic
Roseville, CA 95661-3037 - Phone
- (916) 781-1386
- Fax
- (916) 781-1456
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090106000702 | CA | Practitioner - Internal Medicine | 9133109945 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52426 | CA | MD | Periodontist |
| C52426 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R Bayati MD PC | Medical Specialty | Current |
Accepting new patients |
| Sutter Valley Medical Foundation | Internal Medicine | Current | Accepting new patients |
| Cardiology and Vascular Associates PC | Past | Accepting new patients | |
| Associates in Medicine PC | Internal Medicine | Past | Accepting new patients |
Locations
5120 Ward Ln
Rocklin, CA 95677
Phone (916) 419-4962
2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850
2820 Crooks Rd
Ste 200
Rochester Hills, MI 48309
Phone (248) 852-7484
Interoperability endpoints
- rbayatimd19184@hisp.ehr.sutterhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | 4301066754 | MI | |
| Internal Medicine Physician | 207R00000X | C52426 | CA | Yes |
Addresses
Primary practice location
1 Medical Plaza Dr
Wound Care Clinic
Roseville, CA 95661-3037
Mailing address
5120 Ward LN
Rocklin, CA 95677-2842
Phone (916) 500-2474
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4772285 | Medicaid | MI |
Other providers in Roseville, CA
- Batrana LLC
- Kaylin Bauer
- Marisa Bauer
- Marie Baumrucker
- Bay Area Foot Care, Inc
- Bayside Counseling Center Inc
- William A Beacham
- Daniel C Beal
- Brenda Burten Beale
- Sarah Beale
All providers in Roseville, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.