NPIMap

Individual provider Active NPI

Bala P Annadurai, M.D.

  • Internal Medicine Physician
  • Fremont, CA
National Provider Identifier
1033100516
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A056197 Issued in CA
Practice address
2147 Mowry Ave
Suite D4
Fremont, CA 94538-1724
Phone
(510) 574-0800
Fax
(510) 574-0850
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A056197 CA Primary

Addresses

Primary practice location

2147 Mowry Ave
Suite D4
Fremont, CA 94538-1724

Mailing address

2147 Mowry Ave
Suite D4
Fremont, CA 94538-1724
Phone (510) 574-0800

Other identifiers 2

IdentifierTypeStateIssuer
P00145281OtherRAILROAD MEDICARE
00A561970MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040603000976 CA Practitioner - Internal Medicine 2264414200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2147 Mowry Ave
Suite D4
Fremont, CA 94538-1724
Phone (510) 574-0800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A056197CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Civic Medical Center, Inc. Internal Medicine CurrentSince Oct 1, 2005 Accepting new patients
Hayward Sisters Hospital Past Accepting new patients
Washington Township Hospital District Past Accepting new patients
Avant Inpatient Services Medical Group, Inc Internal Medicine Past Accepting new patients

Locations

2147 Mowry Ave
Ste D4
Fremont, CA 94538
Phone (510) 574-0800

Interoperability endpoints

  • Direct secure messaging: bannadurai13355@direct.whhs.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/EHGAAA/Endpoint/EHGAAA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Masonic HomeUnion City, CA, CCN 555843 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 29, 2020
Sep 29, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1033100516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 MOWRY AVE",
            "address_2": "SUITE D4",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381724",
            "telephone_number": "510-574-0800",
            "fax_number": "510-574-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 MOWRY AVE",
            "address_2": "SUITE D4",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381724",
            "telephone_number": "510-574-0800",
            "fax_number": "510-574-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANNADURAI",
        "first_name": "BALA",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A056197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00145281",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A561970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.