NPIMap

Organization Active NPI

Shyam Bhaskar, M.D. Inc

  • Primary Care Clinic/Center
  • Delano, CA
National Provider Identifier
1154679447
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A74119 Issued in CA
Legal business name
SHYAM BHASKAR, M.D. INC
Practice address
1425 Main St
Delano, CA 93215-1726
Phone
(661) 778-0920
Fax
(661) 778-0919
NPI assigned
Aug 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2013

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

Authorized official

Name
Martha Sepeda
Title
Administrator
Phone
(559) 635-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A74119 CA Primary

Addresses

Primary practice location

1425 Main St
Delano, CA 93215-1726

Mailing address

231 W Noble Ave
Visalia, CA 93277-2631
Phone (559) 635-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080422000883 CA Part B Supplier - Clinic/Group Practice 8022196690 Receives reassigned benefits from 11 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Visalia, CA; Tulare, CA; Hanford, CA; Exeter, CA; Delano, CA; Corcoran, CA
O20130716000557 CA Part A Provider - Rural Health Clinic 8022196690 Practice locations: Delano, CA

Rural health clinic certification: CCN 058982

Legal name
SHYAM BHASKAR MD INC
Doing business as
SHYAM BHASKAR MD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 12, 2015
Last certification
Jan 12, 2015
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Oct 11, 2006 in CA
Enrollment address
1425 Main St
Delano, CA 93215-1726

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2020121Shyam Bhaskar, MD Inc1425 Main St, Delano, CA 93215Certificate of waiverFeb 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Shyam Bhaskar MD Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shyam Bhaskar Individual 5% Or Greater Direct Ownership InterestCeo Jan 1, 2013 100%
5% Or Greater Security InterestCeo Jan 1, 2013 100%
Corporate OfficerCeo Nov 1, 2013 100%
Corporate DirectorOwner/Ceo Jan 1, 2013 100%
Operational/Managerial ControlOwner Jan 1, 2013 100%
Shyam Bhaskar MD Inc Organization, Visalia, CA Corporation 5% Or Greater Direct Ownership Interest Nov 1, 2010 100%
Operational/Managerial Control Nov 1, 2010 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Shyam Bhaskar, MD
    • Internal Medicine Physician
    • Visalia, CA
    • NPI 1194788158

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Corporate Director, Corporate Officer, Operational/Managerial Control

    CMS ownership
  • Shyam Bhaskar MD Inc
    • Internal Medicine Physician
    • Visalia, CA
    • NPI 1609063429

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1154679447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 W NOBLE AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932772631",
            "telephone_number": "559-635-7100",
            "fax_number": "559-635-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 MAIN ST",
            "city": "DELANO",
            "state": "CA",
            "postal_code": "932151726",
            "telephone_number": "661-778-0920",
            "fax_number": "661-778-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHYAM BHASKAR, M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-17",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "SEPEDA",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "559-635-7100"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A74119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delano, CA

Sources for this page

Verify at the official NPI Registry.