Ira Paula Wardono, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A112875 Issued in CA

Practice address

18321 Clark St
Tarzana, CA 91356-3501

Phone

(818) 881-0800

NPI assigned

Jun 19, 2007

Sex

Female

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 3

Other names 1

• Ira Paula Yusup Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Cedars-Sinai Medical Care Foundation

  • Specialist
  • Los Angeles, CA
  • NPI 1316984388
  Medicare reassignment NPD
• Children'S Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653

  Pediatrics

  Medicare reassignment NPD
• Vanguard Medical Corporation

  • Rural Health Clinic/Center
  • Shafter, CA
  • NPI 1609281310
  Medicare reassignment NPD
• Vanguard Medical Corporation

  • Rural Health Clinic/Center
  • Wasco, CA
  • NPI 1164270807
  NPD
• Vanguard Medical Corporation

  • Rural Health Clinic/Center
  • Wasco, CA
  • NPI 1558801829
  NPD
• Jae J. Kim, M.D.

  • Primary Care Clinic/Center
  • Shafter, CA
  • NPI 1073796843
  NPD (past)
• Valley Children'S Medical Group

  • Pediatrics Physician
  • Modesto, CA
  • NPI 1437555265
  NPD (past)
• United Health and Hospital Services, Inc.

  • Family Medicine Physician
  • Kingston, PA
  • NPI 1316978885
  NPD (past)
• Wilkes-Barre Academic Medicine LLC

  • Family Medicine Physician
  • Kingston, PA
  • NPI 1669613063

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1134324148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6430 W SUNSET BLVD",
            "address_2": "SUITE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287900",
            "telephone_number": "323-361-2337",
            "fax_number": "323-361-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18321 CLARK ST",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563501",
            "telephone_number": "818-881-0800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 34th St",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933012237",
            "country_code": "US",
            "telephone_number": "323-361-1677",
            "fax_number": "323-361-8566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARDONO",
        "first_name": "IRA",
        "middle_name": "PAULA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD431846",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A112875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020378080001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "001993563",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FPH",
            "identifier": "824184",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRA",
            "last_name": "YUSUP",
            "middle_name": "PAULA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walter C. Sheets, M.D., Inc.
• Richard L. Walter, M.D.
• Patricia Walters, DPM
• Herman Lee Walton
• Chris Y Wang, M.D.
• Sandra Warlick
• Matthew Garrett Warner
• Randall Warner, M.F.T. TRAINEE
• Sherry Jeanette Warschaw, MFT
• Alexzandria Washington, M.S., BCBA

• Pediatrics Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.