NPIMap

Individual provider Active NPI

Sushant Bandarpalle, D.O.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1487073839
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A15221 Issued in CA
Practice address
808 W 58TH St
Los Angeles, CA 90037-3632
Phone
(323) 541-1411
NPI assigned
Apr 14, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY
Family Medicine Physician 207Q00000X 20A15221 CA Primary

Addresses

Primary practice location

808 W 58TH St
Los Angeles, CA 90037-3632

Mailing address

60 Sand Hill Rd
Jamesburg, NJ 08831-1162
Phone (609) 235-7399

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
I20171116001390 CA Practitioner - Family Practice 8820392665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John'S Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

326 W 23Rd St
Los Angeles, CA 90007-2612
Phone (323) 541-1600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15221CAMDAddiction (Substance Use Disorder) Counselor
20A15221CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Johns Community Health CurrentSince Sep 16, 2017 Accepting new patients
St. Johns Community Health CurrentSince Sep 16, 2017 Accepting new patients
St. Johns Community Health Current Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients
St. Johns Community Health Past Accepting new patients

Locations

2115 N Wilmington Ave
Compton, CA 90222
Phone (310) 603-1332

326 W 23rd St
Los Angeles, CA 90007
Phone (323) 366-1100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sushant.bandarpalle@sjch.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 24

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. John'S Community HealthLos Angeles, CA, CCN 051042 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthCompton, CA, CCN 551071 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 551072 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 551069 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 551070 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 551154 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthCompton, CA, CCN 551160 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 751084 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLynwood, CA, CCN 751083 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 751085 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthCompton, CA, CCN 751133 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 751173 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 751188 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 751892 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 921038 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN 921835 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthCompton, CA, CCN A01027 Federally qualified health center Corporate Officer Jun 27, 2023
St.John'S Well Child and Family CenterLos Angeles, CA, CCN 921974 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN A01847 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN A01846 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthSan Bernardino, CA, CCN A01849 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jun 27, 2023
Jun 27, 2023
St. John'S Community HealthLos Angeles, CA, CCN A01855 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthSan Jacinto, CA, CCN A01858 Federally qualified health center Corporate Officer Jun 27, 2023
St. John'S Community HealthIndio, CA, CCN A01921 Federally qualified health center Corporate Officer Jun 27, 2023

Owned or controlled facilities with NPI records 24

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 24

Organizations & group practices 5

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": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1487073839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 SAND HILL RD",
            "city": "JAMESBURG",
            "state": "NJ",
            "postal_code": "088311162",
            "telephone_number": "609-235-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDARPALLE",
        "first_name": "SUSHANT",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A15221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.