Individual provider Active NPI

Maryam Dolatshahi, M.D.

  • Student in an Organized Health Care Education/Training Program
  • San Jose, CA
National Provider Identifier
1992053581
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
455 Oconnor Dr Ste 250
San Jose, CA 95128-1644
Phone
(530) 750-9742
NPI assigned
Aug 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

455 Oconnor Dr Ste 250
San Jose, CA 95128-1644

Mailing address

455 Oconnor Dr Ste 250
San Jose, CA 95128-1644
Phone (530) 750-9742

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171102002345 CA Practitioner - Family Practice 4284990540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Davis School of Medicine, 2014
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)

1071 Blossom Hill Rd
San Jose, CA 95123-1105
Phone (408) 445-4010

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
140286CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Oct 16, 2017 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Oct 16, 2017 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Pih Health Good Samaritan Hospital Past Accepting new patients
El Camino Hospital 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

2350 W El Camino Real
Fl 2
Mountain View, CA 94040
Phone (650) 691-6174

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

1071 Blossom Hill Rd
San Jose, CA 95123
Phone (408) 445-4010

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

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

Interoperability endpoints

  • Direct secure messaging: mdolatshahi370317@hisp.ehr.sutterhealth.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1992053581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 OCONNOR DR STE 250",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281644",
            "telephone_number": "530-750-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 OCONNOR DR STE 250",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281644",
            "telephone_number": "530-750-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLATSHAHI",
        "first_name": "MARYAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.