Pranav R. Mehta, M.D., Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G078698 Issued in CA

Legal business name

PRANAV R. MEHTA, M.D., INC.

Practice address

12047 4TH St
Yucaipa, CA 92399-2735

Phone

(909) 797-5101

Fax

(909) 797-5103

NPI assigned

Nov 2, 2007

Organization subpart

No

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

Authorized official

Name

Pranav Raghuvir Mehta, M.D.NPI 1467527762

Title

President

Phone

(909) 797-5101

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pranav Raghuvir Mehta, M.D.

  • Family Medicine Physician
  • Yucaipa, CA
  • NPI 1467527762
  Medicare reassignment NPD Authorized official
• Rebecca Ann Baldwin, AGPCNP-C

  • Primary Care Nurse Practitioner
  • Yucaipa, CA
  • NPI 1538797022
  Medicare reassignment

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1962681270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12047 4TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992735",
            "telephone_number": "909-797-5101",
            "fax_number": "909-797-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12047 4TH ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992735",
            "telephone_number": "909-797-5101",
            "fax_number": "909-797-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRANAV R. MEHTA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "PRANAV",
        "authorized_official_middle_name": "RAGHUVIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-797-5101",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G078698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G786980",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080160338",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.