Harold S. Budhram, MD, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G319730 Issued in CA

Legal business name

HAROLD S. BUDHRAM, MD, INC.

Practice address

5145 Shasta Dam Blvd
Shasta Lake, CA 96019-9403

Phone

(530) 275-5421

Fax

(530) 275-5156

NPI assigned

Feb 1, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Harold Shamnarine Budhram, M.D.

Title

President

Phone

(530) 275-5421

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Harold S. Budhram, MD Former legal business name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 553954

Legal name

HAROLD S BUDHRAM MD INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 28, 2002

Last certification

Dec 13, 2017

Ownership / control type

1B

Most recent change of ownership

Jan 1, 2010 (1 total)

Facility address

5145 Shasta Dam Blvd
Shasta Lake, CA 96019

Locations

Practitioners 2

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

• Jeri Rene'E Cates, RN, MSN, FNPC

  • Nurse Practitioner
  • Shasta Lake, CA
  • NPI 1972831519
  NPD (past)
• Peggy Jane Deforest, P.A.

  • Physician Assistant
  • Shasta Lake, CA
  • NPI 1447460522
  NPD (past)

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1346572468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5145 SHASTA DAM BLVD",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199403",
            "telephone_number": "530-275-5421",
            "fax_number": "530-275-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5145 SHASTA DAM BLVD",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199403",
            "telephone_number": "530-275-5421",
            "fax_number": "530-275-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAROLD S. BUDHRAM, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-01",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "BUDHRAM",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "SHAMNARINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-275-5421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G319730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53954F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harold S. Budhram, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• James G Earle, M.P.T., C.S.C.S.
• Samantha Enzler
• Darrin Ferguson, RN
• Rebecca Ann Fisher, LCSW
• Melodie G. Gill, FNP
• Healing Currents Counseling
• Thinh Tan Hoang, PHARM.D
• Bao Ying Huynh, RPH
• Kelsey H Jewett, O.D.
• Zhibin Ji, DDS

• Family Medicine Physician in Shasta Lake, CA
• Providers in Shasta Lake, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.