Active NPI
Ravindra Gautam, M.D., Inc.
- Internal Medicine Physician
- Barstow, CA
National Provider Identifier
1366490310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- RAVINDRA GAUTAM, M.D., INC.
- Practice address
- 930 W Main St
Barstow, CA 92311-2654 - Phone
- (760) 256-1004
- Fax
- (760) 256-1055
- NPI assigned
- May 4, 2006
- Organization subpart
- Yes
- Parent organization
- RAVINDRA GAUTAM MD
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ravindra Moharpal Gautam
- Title
- Ceo
- Phone
- (760) 256-1004
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiac Rehabilitation Registered Nurse | 163WC3500X | |||
| Internal Medicine Physician | 207R00000X | Primary | ||
| Hospitalist Physician | 208M00000X | |||
| Cardiac Rehabilitation Clinic/Center | 261QR0404X |
Addresses
Primary practice location
930 W Main St
Barstow, CA 92311-2654
Mailing address
PO Box 1519
Barstow, CA 92312-1519
Phone (760) 256-1004
Other practice location 1
121 S 7th Ave Ste A
Barstow, CA 92311-3059
Phone (760) 818-4228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051029000320 | CA | Part B Supplier - Clinic/Group Practice | 4082509229 |
Receives reassigned benefits from 5 practitioners Practice locations: Barstow, CA |
| O20250507000921 | CA | Part B Supplier - Intensive Cardiac Rehabilitation | 4082509229 |
Receives reassigned benefits from 1 practitioner Practice locations: Barstow, CA |
National Provider Directory
National Provider Directory- Tax ID family
- Ravindra Gautam MD Inc
- Part of
- Ravindra Gautam MD Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Case Manager/Care Coordinator
- Barstow, CA
- NPI 1689564072
Locations
121 S 7th Ave
Ste A
Barstow, CA 92311
Phone (760) 818-4228
930 W Main St
Ste A
Barstow, CA 92311
801 E Mountain View St
Ste E
Barstow, CA 92311
Phone (760) 252-2700
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Barstow, CA
- NPI 1891791703
CA, Internal Medicine
-
- Clinical Cardiac Electrophysiology Physician
- Glendale, CA
- NPI 1861410029
CA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732665600000",
"number": "1366490310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1519",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923121519",
"telephone_number": "760-256-1004",
"fax_number": "760-256-1055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 W MAIN ST",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923112654",
"telephone_number": "760-256-1004",
"fax_number": "760-256-1055"
}
],
"practiceLocations": [
{
"address_1": "121 S 7th Ave Ste A",
"address_purpose": "LOCATION",
"city": "Barstow",
"state": "CA",
"postal_code": "923113059",
"country_code": "US",
"telephone_number": "760-818-4228",
"fax_number": "760-818-4573",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "RAVINDRA GAUTAM, M.D., INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "RAVINDRA GAUTAM MD",
"enumeration_date": "2006-05-04",
"last_updated": "2024-11-27",
"certification_date": "2024-11-27",
"status": "A",
"authorized_official_last_name": "GAUTAM",
"authorized_official_first_name": "RAVINDRA",
"authorized_official_middle_name": "MOHARPAL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "760-256-1004"
},
"taxonomies": [
{
"code": "163WC3500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse, Cardiac Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "208M00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Hospitalist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QR0404X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Cardiac Facilities",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; 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.