Organization Active NPI

Jagan N. Bansal, M.D., Inc.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1013099936
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JAGAN N. BANSAL, M.D., INC.
Practice address
443 S Soto St
Los Angeles, CA 90033-4315
Phone
(323) 263-6103
Fax
(323) 263-2004
NPI assigned
Oct 19, 2006
Last updated
Sep 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Authorized official

Name
Dr. Jagan Nath Bansal, M.D.NPI 1932102456
Title
Ceo
Phone
(323) 478-1101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

443 S Soto St
Los Angeles, CA 90033-4315

Mailing address

5540 N Figueroa St
Los Angeles, CA 90042-4120
Phone (323) 478-1101

Other identifiers 1

IdentifierTypeStateIssuer
GR0100470MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050421000957 CA Part B Supplier - Clinic/Group Practice 9739127515 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1013099936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5540 N FIGUEROA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900424120",
            "telephone_number": "323-478-1101",
            "fax_number": "323-255-2745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 S SOTO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900334315",
            "telephone_number": "323-263-6103",
            "fax_number": "323-263-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAGAN N. BANSAL, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "JAGAN",
        "authorized_official_middle_name": "NATH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-478-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.