Individual provider Active NPI

Suvarna Bhandaru, M.D.

  • Pediatrics Physician
  • Toledo, OH
National Provider Identifier
1417934043
Registry record updated Jun 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.045159 Issued in OH
Practice address
4126 N Holland Sylvania Rd Ste 220
Toledo, OH 43623-3537
Phone
(419) 517-7600
Fax
(419) 517-7610
NPI assigned
Dec 24, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.045159 OH Primary

Addresses

Primary practice location

4126 N Holland Sylvania Rd Ste 220
Toledo, OH 43623-3537

Mailing address

2200 Jefferson Ave FL 5
Toledo, OH 43604-7102

Other identifiers 1

IdentifierTypeStateIssuer
0452871MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20170731003590 OH Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 7719147081

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
L Bhandaru MD & S Bhandaru MD Inc Pediatrics PastSince Dec 31, 1975 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498780800000",
    "number": "1417934043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 JEFFERSON AVE FL 5",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436047102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4126 N HOLLAND SYLVANIA RD STE 220",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233537",
            "telephone_number": "419-517-7600",
            "fax_number": "419-517-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHANDARU",
        "first_name": "SUVARNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-24",
        "last_updated": "2017-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.045159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0452871",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.