NPIMap

Individual provider Active NPI

Hamid Kakavandi, DO

  • Surgery Physician
  • Bastrop, LA
National Provider Identifier
1154414977
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
321115 Issued in LA
Practice address
420 S Vine St
Bastrop, LA 71220
Phone
(318) 283-3955
Fax
(318) 239-8955
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 321115 LA Primary
Surgery Physician 208600000X 03405 IA

Addresses

Primary practice location

420 S Vine St
Bastrop, LA 71220

Mailing address

PO Box 293
Bastrop, LA 71221-0293
Phone (318) 283-3955

Other practice location 1

901 Montgomery St
Decorah, IA 52101-2325
Phone (563) 382-2911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210329002440 WY Practitioner - General Surgery 1951207885 Reassigns benefits to 1 organization
I20260514003525 CA Practitioner - General Surgery 1951207885 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2752 Harrison Ave
Suite a
Eureka, CA 95501-4738
Phone (714) 449-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03405IAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Riverton Physician Practices LLC CurrentSince Apr 9, 2021 Accepting new patients
Riverton Physician Practices, LLC Current Accepting new patients
Riverton Physician Practices LLC CurrentSince Apr 9, 2021 Accepting new patients
Lander Valley Physician Practices, LLC Past Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients
Clarinda Regional Health Center Past Accepting new patients

Locations

1005 College View Dr
Riverton, WY 82501
Phone (307) 857-3486

Interoperability endpoints

  • Direct secure messaging: hkakavandi3941992@oc.providencedirect.org
  • Direct secure messaging: hamid.kakavandi.1@5036.direct.athenahealth.com

Organizations & group practices 7

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 5

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1154414977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 293",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712210293",
            "telephone_number": "318-283-3955",
            "fax_number": "318-239-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S VINE ST",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "71220",
            "telephone_number": "318-283-3955",
            "fax_number": "318-239-8955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Montgomery St",
            "address_purpose": "LOCATION",
            "city": "Decorah",
            "state": "IA",
            "postal_code": "521012325",
            "country_code": "US",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-3102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAKAVANDI",
        "first_name": "HAMID",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "321115",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "03405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.