Individual provider Active NPI

Shyam Bhansali, D.O.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Los Angeles, CA
National Provider Identifier
1013396068
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
20A17528 Issued in CA
Practice address
1520 San Pablo St Ste 1000
Los Angeles, CA 90033
Phone
(323) 442-5100
NPI assigned
May 22, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 20A17528 CA Primary

Addresses

Primary practice location

1520 San Pablo St Ste 1000
Los Angeles, CA 90033

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5100

Other practice location 1

3600 NW Samaritan Dr
Corvallis, OR 97330-3737
Phone (541) 768-4906

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shyam.bhansali@direct.usc.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR, WA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20191030000810 CA Practitioner - Hospice/Palliative CarePractitioner - Internal Medicine 5092069708 Reassigns benefits to 1 organization
I20230306001239 OR Practitioner - Hospice/Palliative Care 5092069708 Reassigns benefits to 1 organization
I20230306001374 WA Practitioner - Hospice/Palliative Care 5092069708 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A17528CAMDHospice and Palliative Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc Internal Medicine CurrentSince Sep 1, 2019 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Mar 6, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 6, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Mar 6, 2023 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Sep 1, 2019 Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1520 San Pablo St
Ste 1000
Los Angeles, CA 90033
Phone (626) 457-5839

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 5

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": "1432252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1013396068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90033",
            "telephone_number": "323-442-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 NW Samaritan Dr",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973303737",
            "country_code": "US",
            "telephone_number": "541-768-4906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BHANSALI",
        "first_name": "SHYAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "20A17528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shyam.bhansali@direct.usc.edu",
            "affiliation": "Y",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St Ste 1000",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "90033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.