Individual provider Active NPI

Bijan Sorouri, M.D.

  • Specialist
  • Newark, DE
National Provider Identifier
1114016615
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C10003167 Issued in DE
Practice address
10 Darwin Dr
Suite C
Newark, DE 19711-6658
Phone
(302) 453-9171
Fax
(302) 453-0732
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X C10003167 DE Primary

Addresses

Primary practice location

10 Darwin Dr
Suite C
Newark, DE 19711-6658

Mailing address

10 Darwin Dr
Suite C
Newark, DE 19711-6658
Phone (302) 453-9171

Other identifiers 1

IdentifierTypeStateIssuer
0000059001MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20110617000385 DE Practitioner - Internal Medicine 6103870266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bijan Sorouri M.D. P.a.Group PAC ID 2961680129, 2 clinicians

Practice addresses (Care Compare)

10 Darwin Dr
Newark, DE 19711-6658
Phone (302) 453-9171

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C10003167DEMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Bijan Sorouri M.D. P.a. Specialist CurrentSince Jan 1, 2011 Accepting new patients
Corazon G. Tablang MD PC Past Accepting new patients
Kirkwood Endoscopy Center LLC Past Accepting new patients

Locations

10 Darwin Dr
Newark, DE 19711
Phone (302) 453-9171

10 Darwin Dr
Ste C
Newark, DE 19711
Phone (302) 452-9171

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1114016615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DARWIN DR",
            "address_2": "SUITE C",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197116658",
            "telephone_number": "302-453-9171",
            "fax_number": "302-453-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DARWIN DR",
            "address_2": "SUITE C",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197116658",
            "telephone_number": "302-453-9171",
            "fax_number": "302-453-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOROURI",
        "first_name": "BIJAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "DE",
            "license": "C10003167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000059001",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.