NPIMap

Individual provider Active NPI

Shamik Bhadra, MD

  • Specialist
  • Montebello, CA
National Provider Identifier
1114910908
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A124360 Issued in CA
Practice address
3114 W Beverly Blvd
Montebello, CA 90640
Phone
(323) 726-3868
Fax
(323) 726-3870
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A124360 CA Primary

Addresses

Primary practice location

3114 W Beverly Blvd
Montebello, CA 90640

Mailing address

2149 E Warner Rd Ste 102
Tempe, AZ 85284-3495
Phone (480) 393-0309

Other identifiers 2

IdentifierTypeStateIssuer
949662MedicaidAZ
WA124360MedicaidCA

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
I20130628000450 CA Practitioner - NephrologyPractitioner - Internal Medicine 1557391554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
L a County Nephrology Associates a Medical CorporationGroup PAC ID 3173566536, 11 clinicians

Practice addresses (Care Compare)

3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone (323) 726-3868

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
84.75
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A124360CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
L a County Nephrology Associates a Medical Corporation Specialist CurrentSince May 23, 2024 Accepting new patients
Banner Sun City Medical Group Past Accepting new patients
Sun Health Corporation Past Accepting new patients
Southland Renal Medical Group, Inc. Nephrology Past Accepting new patients

Locations

7900 Pacific Blvd
Huntington Park, CA 90255
Phone (323) 277-9455

3114 W Beverly Blvd
Montebello, CA 90640
Phone (323) 726-1317

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: shamik.bhadra.1@16656.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1114910908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843495",
            "telephone_number": "480-393-0309",
            "fax_number": "480-610-6189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3114 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "90640",
            "telephone_number": "323-726-3868",
            "fax_number": "323-726-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHADRA",
        "first_name": "SHAMIK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A124360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "949662",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "WA124360",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

Verify at the official NPI Registry.