Life Connect Medical, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A86478 Issued in CA

Legal business name

LIFE CONNECT MEDICAL, INC

Practice address

35900 Bob Hope Dr
Suite # 100
Rancho Mirage, CA 92270-1766

Phone

(760) 699-7117

Fax

(760) 699-7750

NPI assigned

Sep 12, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Padma Khanchustambahm, M.D

Title

Owner

Phone

(760) 464-2166

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

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

• Padma Khanchustambham, M.D.

  • Internal Medicine Physician
  • Rancho Mirage, CA
  • NPI 1245243146
  Medicare reassignment NPD
• Wanda K. Long, ACNP-BC

  • Acute Care Nurse Practitioner
  • Palm Desert, CA
  • NPI 1003456609
  Medicare reassignment NPD
• Sofia Peterson, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Yucaipa, CA
  • NPI 1386664498
  Medicare reassignment NPD

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1245489384",
    "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": "760-217-0126",
            "fax_number": "760-699-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35900 BOB HOPE DR",
            "address_2": "SUITE # 100",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701766",
            "telephone_number": "760-699-7117",
            "fax_number": "760-699-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CONNECT MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-12",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "KHANCHUSTAMBAHM",
        "authorized_official_first_name": "PADMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-464-2166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A86478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AV186",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald S. Levey, M.D.
• Scott Alan Levy, M.D.
• Yun Rose Li, M.D., PH.D
• Timothy P Liddy, HAD
• Deborah Liebman, M.D.
• Farhad M Limonadi, MD
• Raymond Ryuyuan Lin, M.D.
• Linda Robertson, Marriage & Family Therapist, Inc.
• Levena Elise Linderholm, PMHNP
• Elisa M Lindley, MD

• Primary Care Clinic/Center in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.