NPIMap

Individual provider Active NPI

Padma Khanchustambham, M.D.

  • Internal Medicine Physician
  • Rancho Mirage, CA
National Provider Identifier
1245243146
Registry record updated Jun 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A86478 Issued in CA
Practice address
35400 Bob Hope Dr
Suite # 209
Rancho Mirage, CA 92270-1772
Phone
(760) 699-7117
Fax
(760) 699-7750
NPI assigned
Aug 14, 2006
Last updated
Jun 8, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A86478 CA Primary

Addresses

Primary practice location

35400 Bob Hope Dr
Suite # 209
Rancho Mirage, CA 92270-1772

Mailing address

36101 Bob Hope Dr
Ste. E-5 #117
Rancho Mirage, CA 92270-2001
Phone (760) 464-2166

Other identifiers 2

IdentifierTypeStateIssuer
A86478OtherCASTATE LICENSE ID
AV500ZOtherCAMEDICARE PTAN

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
I20050804000382 CA Practitioner - Internal Medicine 8325077944 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

35900 Bob Hope Dr
Suite 100
Rancho Mirage, CA 92270-1765
Phone (760) 699-7117

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Life Connect Medical, Inc CurrentSince Sep 15, 2008 Accepting new patients

Locations

35900 Bob Hope Dr
Ste 100
Rancho Mirage, CA 92270
Phone (760) 564-3414

36101 Bob Hope Dr
Ste E5
Rancho Mirage, CA 92270

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1245243146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36101 BOB HOPE DR",
            "address_2": "STE. E-5 #117",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702001",
            "telephone_number": "760-464-2166",
            "fax_number": "760-699-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35400 BOB HOPE DR",
            "address_2": "SUITE # 209",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701772",
            "telephone_number": "760-699-7117",
            "fax_number": "760-699-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANCHUSTAMBHAM",
        "first_name": "PADMA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A86478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE ID",
            "identifier": "A86478",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AV500Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.