Individual provider Active NPI

Kavitha Reddy Bhatia, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1609810357
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A90588 Issued in CA
Practice address
201 Avondale Ave
Los Angeles, CA 90049-3601
Phone
(310) 210-1302
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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 A90588 CA Primary

Addresses

Primary practice location

201 Avondale Ave
Los Angeles, CA 90049-3601

Mailing address

1811 Wilshire Blvd Ste 110
Santa Monica, CA 90403-5626
Phone (310) 453-9010

Other practice location 1

1811 Wilshire Blvd Ste 110
Santa Monica, CA 90403-5626
Phone (310) 453-9010

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbhatia473406@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20060802000282 CA Practitioner - Pediatric Medicine 5193738599 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A90588CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Saint Johns Medical Foundation Pediatrics CurrentSince Jul 1, 2018 Accepting new patients

Locations

12414 Exposition Blvd
Los Angeles, CA 90064
Phone (310) 272-7640

2336 Santa Monica Blvd
Ste 204
Santa Monica, CA 90404
Phone (310) 453-4477

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

1811 Wilshire Blvd
Ste 110
Santa Monica, CA 90403
Phone (310) 453-9010

Interoperability endpoints

  • Direct secure messaging: kbhatia473406@oc.providencedirect.org

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Coshocton Regional Medical CenterCoshocton, OH, CCN 360109 Hospital Corporate Director Oct 31, 2016
Coshocton Regional Medical Center Warsaw ClinicWarsaw, OH, CCN 363440 Rural health clinic Corporate Director Oct 31, 2016

Owned or controlled facilities with NPI records 2

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

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1609810357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 WILSHIRE BLVD STE 110",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035626",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 AVONDALE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900493601",
            "telephone_number": "310-210-1302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1811 Wilshire Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904035626",
            "country_code": "US",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BHATIA",
        "first_name": "KAVITHA",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A90588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbhatia473406@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1811 Wilshire Blvd Ste 110",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904035626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.