Individual provider Active NPI

Rajneesh K Bhalla, MD

  • Internal Medicine Physician
  • Port Saint Lucie, FL
National Provider Identifier
1326062167
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME71005 Issued in FL
Practice address
1701 SE Hillmoor Dr
Suite C-12
Port Saint Lucie, FL 34952-7541
Phone
(772) 398-8844
Fax
(772) 398-0012
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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 ME71005 FL Primary

Addresses

Primary practice location

1701 SE Hillmoor Dr
Suite C-12
Port Saint Lucie, FL 34952-7541

Mailing address

1701 SE Hillmoor Dr
Suite C-12
Port Saint Lucie, FL 34952-7541
Phone (772) 398-8844

Other identifiers 1

IdentifierTypeStateIssuer
009389600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20100406000259 FL Practitioner - Internal Medicine 7416083118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1701 SE Hillmoor Dr
Suite C 12
Port St Lucie, FL 34952-7541
Phone (772) 398-8844

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME71005FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rajneesh K Bhalla MD PA Internal Medicine CurrentSince Jan 7, 2010 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1701 SE Hillmoor Dr
Ste C12
Port St Lucie, FL 34952
Phone (561) 529-3100

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 4

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383868800000",
    "number": "1326062167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "SUITE C-12",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527541",
            "telephone_number": "772-398-8844",
            "fax_number": "772-398-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "SUITE C-12",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527541",
            "telephone_number": "772-398-8844",
            "fax_number": "772-398-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHALLA",
        "first_name": "RAJNEESH",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2013-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME71005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009389600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.