Individual provider Active NPI

Sivakrishna Bhandaru, MD

  • Internal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1629017884
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C159417 Issued in CA
Practice address
1201 Alhambra Blvd Ste 400
Sacramento, CA 95816-5243
Phone
(916) 733-5098
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35087513 OH
Hospitalist Physician 208M00000X 35.087513 OH
Internal Medicine Physician 207R00000X C159417 CA Primary

Addresses

Primary practice location

1201 Alhambra Blvd Ste 400
Sacramento, CA 95816-5243

Mailing address

PO Box 255228
Sacramento, CA 95865-5228

Other identifiers 1

IdentifierTypeStateIssuer
2673950MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060808000605 OH Practitioner - Internal Medicine 6800899030 Reassigns benefits to 1 organization
I20201113002509 CA Practitioner - Internal Medicine 6800899030 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C159417CAMDInternal Medicine Physician
35087513OHMDInternal Medicine Physician
35.087513OHMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mvhe Inc Internal Medicine CurrentSince Sep 25, 2017 Accepting new patients
Mvhe, Inc Internal Medicine CurrentSince Sep 25, 2017 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Dec 1, 2020 Accepting new patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Dec 1, 2020 Accepting new patients
Mvhe Inc Internal Medicine Current Accepting new patients

Locations

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

1201 Alhambra Blvd
Ste 400
Sacramento, CA 95816
Phone (916) 733-5090

722 N Fairfield Rd
Beavercreek, OH 45434
Phone (937) 208-7000

2451 Wayne Ave
Dayton, OH 45420
Phone (937) 252-1831

30 E Apple St
Ste 6250
Dayton, OH 45409
Phone (937) 208-2900

33 W Rahn Rd
Ste 101
Kettering, OH 45429
Phone (937) 434-5380

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1629017884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 ALHAMBRA BLVD STE 400",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165243",
            "telephone_number": "916-733-5098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHANDARU",
        "first_name": "SIVAKRISHNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35087513",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.087513",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C159417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2673950",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.