Active NPI
Hawantu M Bundu, NURSE
- Licensed Practical Nurse
- Gilbert, AZ
National Provider Identifier
1013632256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN164864
- Practice address
- 633 E Ray Rd Ste 130
Gilbert, AZ 85296-4206 - Phone
- (480) 812-3680
- NPI assigned
- Oct 10, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN164864 | OH | Primary |
Addresses
Primary practice location
633 E Ray Rd Ste 130
Gilbert, AZ 85296-4206
Mailing address
633 E Ray Rd Ste 130
Gilbert, AZ 85296-4206
Phone (480) 812-3680
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PN164864 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | SANTANVALLEY | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN164864 | OH | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trusted Hands Residential Care LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Assisted Living Facility (Behavioral Disturbances)
- Casa Grande, AZ
- NPI 1376229823
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665360000000",
"number": "1013632256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 E RAY RD STE 130",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852964206",
"telephone_number": "480-812-3680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 E RAY RD STE 130",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852964206",
"telephone_number": "480-812-3680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNDU",
"first_name": "HAWANTU",
"middle_name": "M",
"credential": "NURSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-10",
"last_updated": "2022-10-10",
"certification_date": "2022-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN164864",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PN164864",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "SANTANVALLEY",
"affiliation": "N",
"endpointDescription": "HOMEHEALTHAGENCY",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "633 E Ray Rd Ste 130",
"city": "Gilbert",
"state": "AZ",
"country_code": "US",
"postal_code": "852964206",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.