Sourabh Suryadevara, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A131476 Issued in CA

Practice address

11333 Sepulveda Blvd
Mission Hills, CA 91345-1116

Phone

(818) 365-9531

Fax

(818) 837-5741

NPI assigned

Jun 20, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Internal Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Facey Medical FoundationGroup PAC ID 3173436276, 324 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Holy Cross Medical Center Hospital, Mission Hills, CA, CCN 050278
• Henry Mayo Newhall Hospital Hospital, Valencia, CA, CCN 050624

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: ssuryadevara446060@oc.providencedirect.org

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.

• Providence Facey Medical Foundation

  • Internal Medicine Physician
  • Valencia, CA
  • NPI 1710031588
  Medicare reassignment Care Compare group NPD
• Providence Facey Medical Foundation

  • Multi-Specialty Clinic/Center
  • Irvine, CA
  • NPI 1891348447
  NPD
• Providence Facey Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
  • NPI 1194083824
  NPD (past)

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

• Henry Mayo Newhall Memorial Hospital

  • General Acute Care Hospital
  • Valencia, CA
  • NPI 1780668434
  Care Compare affiliation
• Providence Health System - Southern California

  • General Acute Care Hospital
  • Mission Hills, CA
  • NPI 1477587632
  Care Compare affiliation

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414713600000",
    "number": "1043505969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5559",
            "fax_number": "818-792-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11333 SEPULVEDA BLVD",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451116",
            "telephone_number": "818-365-9531",
            "fax_number": "818-837-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURYADEVARA",
        "first_name": "SOURABH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2014-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "249251",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A131476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A1314760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yoojin Suh, FNP
• Fidelis M Sumampong, N.P.
• Sunshine Health and Wellness LLC
• Supreme Care Group
• Arshia S Surti, M.D.
• Paul Sussman, MD.
• Pharnuk Suthipinijtham, DO.
• Richard G Swanberg, M.D.
• Armin Tahoori, M.D.
• Sheila Hsiu Chen Tai, MD.

• Internal Medicine Physician in Mission Hills, CA
• Providers in Mission Hills, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.