Individual provider Active NPI

Pushan Chowdhury, MD

  • Pediatrics Physician
  • Corona, CA
National Provider Identifier
1013999218
Registry record updated Nov 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C55148 Issued in CA
Practice address
2055 Kellogg Ave
Corona, CA 92879-3111
Phone
(186) 698-4748
NPI assigned
Nov 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33097 AZ
Pediatrics Physician 208000000X C55148 CA Primary

Addresses

Primary practice location

2055 Kellogg Ave
Corona, CA 92879-3111

Mailing address

2055 Kellogg Ave
Corona, CA 92879-3111

Other identifiers 1

IdentifierTypeStateIssuer
908163MedicaidAZ

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
I20151222001185 CA Practitioner - Pediatric Medicine 8921052796 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C55148CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Pediatrics CurrentSince Feb 24, 2020 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Feb 24, 2020 Accepting new patients

Locations

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

10243 Genetic Center Dr
San Diego, CA 92121
Phone (858) 499-2704

Interoperability endpoints

  • Direct secure messaging: pchowdhury153113@direct.renown.org

Organizations & group practices 3

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447977600000",
    "number": "1013999218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 KELLOGG AVE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 KELLOGG AVE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793111",
            "telephone_number": "186-698-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOWDHURY",
        "first_name": "PUSHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2015-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "33097",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C55148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "908163",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

Verify at the official NPI Registry.