Agustinus Suhardja, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A89588 Issued in CA

Practice address

828 S Grand Ave Ste 104
Glendora, CA 91740-4856

Phone

(626) 963-2057

Fax

(626) 963-4298

NPI assigned

May 23, 2007

Last updated

Nov 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

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

Specialty

Diagnostic Radiology

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital - Downey Hospital, Downey, CA, CCN 050139

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Glendora Radiological Assoc Inc

  • Diagnostic Radiology Physician
  • Covina, CA
  • NPI 1992797070
  Medicare reassignment NPD
• North Oc Imaging JV, LLC

  • Radiology Clinic/Center
  • Chino Hills, CA
  • NPI 1376209940
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• North Oc Imaging JV, LLC

  • Radiology Clinic/Center
  • Irvine, CA
  • NPI 1952026643
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Woodland Hills, CA
  • NPI 1952333478
  NPD
• Magnetic Imaging Medical Group Inc

  dba Medical Imaging Center of Huntington Beach

  • Diagnostic Radiology Physician
  • Huntington Beach, CA
  • NPI 1861446551
  NPD (past)
• Orthopaedic Medical Group & Athletic Rehabilitation Center, Inc

  • Orthopaedic Surgery Physician
  • West Covina, CA
  • NPI 1174683643
  NPD (past)
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD (past)
• St Jude Hospital Inc

  dba Providence St. Jude Medical Center

  • General Acute Care Hospital
  • Fullerton, CA
  • NPI 1194926279
  NPD (past)
• Campus Garden Imaging PA

  • Diagnostic Radiology Physician
  • Garden City, KS
  • NPI 1184676629
  NPD (past)

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

• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital - Downey

  • General Acute Care Hospital
  • Downey, CA
  • NPI 1518012301
  Care Compare affiliation

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1235349473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6869",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928636869",
            "telephone_number": "714-571-5000",
            "fax_number": "714-571-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 S GRAND AVE STE 104",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404856",
            "telephone_number": "626-963-2057",
            "fax_number": "626-963-4298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUHARDJA",
        "first_name": "AGUSTINUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KS",
            "license": "04-34805",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D0078407",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101256807",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A89588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tori Strobel-Sabatino
• Bryan James Strycula, MS
• Cynthia Ann Stuart, M.D.
• Irene Su
• Sudario Home Health Care, Inc.
• Dallas Marie Sullivan
• Susan J. Lee, DMD, MD Inc (Glendora Oral Surgery and Implant Center)
• Acacia Sutherland, PA-C
• Swapna V Phadnis MD Inc
• Miriam Antonia Swartz, SLPA

• Diagnostic Radiology Physician in Glendora, CA
• Providers in Glendora, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.