NPIMap

Individual provider Active NPI

Ashvin V Bhutwala, MD

  • Internal Medicine Physician
  • Victorville, CA
National Provider Identifier
1396851580
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A051481 Issued in CA
Practice address
17199 Yuma St
Ste 1
Victorville, CA 92395-5886
Phone
(760) 244-1155
Fax
(760) 244-1115
NPI assigned
Aug 22, 2006
Last updated
Nov 16, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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 A051481 CA Primary

Addresses

Primary practice location

17199 Yuma St
Ste 1
Victorville, CA 92395-5886

Mailing address

17199 Yuma St
Ste 1
Victorville, CA 92395-5886
Phone (760) 244-1155

Other identifiers 1

IdentifierTypeStateIssuer
00A514810MedicaidCA

Other names 1

  • Dr. Ashvin V. Bhutwala Professional name

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
I20110511000791 CA Practitioner - Internal Medicine 0749466548 Practice locations: Victorville, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

17199 Yuma St
Victorville, CA 92395-5886
Phone (760) 952-9555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51481CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary Medical Center Past Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients
Victor Valley Community Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1396851580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17199 YUMA ST",
            "address_2": "STE 1",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955886",
            "telephone_number": "760-244-1155",
            "fax_number": "760-244-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17199 YUMA ST",
            "address_2": "STE 1",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955886",
            "telephone_number": "760-244-1155",
            "fax_number": "760-244-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHUTWALA",
        "first_name": "ASHVIN",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A051481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A514810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHVIN",
            "last_name": "BHUTWALA",
            "middle_name": "V.",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.