Individual provider Active NPI

Poonam Pranita Chandra, N.P.

  • Nurse Practitioner
  • Modesto, CA
National Provider Identifier
1992010268
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NPF19930 Issued in CA
Practice address
1409 E Briggsmore Ave
Modesto, CA 95355-2707
Phone
(209) 550-4720
NPI assigned
Aug 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 19930 CA
Nurse Practitioner 363L00000X NPF19930 CA Primary

Addresses

Primary practice location

1409 E Briggsmore Ave
Modesto, CA 95355-2707

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 521-6097

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161101000742 CA Practitioner - Nurse Practitioner 1052699741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2800 L St
Sacramento, CA 95816-5616

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
19930CAMDSpeech-Language Pathologist
NPF19930CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter North Medical Foundation Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: pchandra353046@hisp.ehr.sutterhealth.org

Organizations & group practices 2

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": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1992010268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-521-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 E BRIGGSMORE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552707",
            "telephone_number": "209-550-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDRA",
        "first_name": "POONAM",
        "middle_name": "PRANITA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "CA",
            "license": "19930",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NPF19930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.