Individual provider Active NPI

Ishwarlal Bhuta, MD

  • Vascular Surgery Physician
  • Montgomery, AL
National Provider Identifier
1598823122
Registry record updated Feb 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
6376 Issued in AL
Practice address
1722 Pine Street
Suite 801
Montgomery, AL 36106
Phone
(334) 263-1026
Fax
(334) 263-1027
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 6376 AL
Vascular Surgery Physician 2086S0129X 6376 AL Primary

Addresses

Primary practice location

1722 Pine Street
Suite 801
Montgomery, AL 36106

Mailing address

1722 Pine Street
Suite 801
Montgomery, AL 36106
Phone (334) 263-1026

Other identifiers 1

IdentifierTypeStateIssuer
000000434MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20101201000781 AL Practitioner - Vascular SurgeryPractitioner - General Surgery 9931395019 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6376ALMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Hospital & Clinic, Inc. CurrentSince Mar 1, 2014 Accepting new patients
Jackson Hospital and Clinic, Inc. Vascular Surgery CurrentSince Mar 1, 2014 Accepting new patients
Jackson Hospital and Clinic, Inc. Current Accepting new patients

Locations

1725 Pine St
Montgomery, AL 36106
Phone (334) 293-8000

1758 Park Pl
Ste 300
Montgomery, AL 36106
Phone (334) 274-1204

1722 Pine St
Ste 503
Montgomery, AL 36106
Phone (334) 240-2337

1722 Pine St
Ste 801
Montgomery, AL 36106
Phone (334) 239-7059

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391731200000",
    "number": "1598823122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE STREET",
            "address_2": "SUITE 801",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36106",
            "telephone_number": "334-263-1026",
            "fax_number": "334-263-1027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 PINE STREET",
            "address_2": "SUITE 801",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36106",
            "telephone_number": "334-263-1026",
            "fax_number": "334-263-1027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHUTA",
        "first_name": "ISHWARLAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2014-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "6376",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AL",
            "license": "6376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000434",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.