Individual provider Active NPI

Anju Beesetty, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Lake Havasu City, AZ
National Provider Identifier
1679254536
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2082 Mesquite Ave Ste 100a
Lake Havasu City, AZ 86403-6710
Phone
(928) 453-2727
Fax
(928) 453-2828
NPI assigned
Jul 25, 2023
Last updated
Jul 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2082 Mesquite Ave Ste 100a
Lake Havasu City, AZ 86403-6710

Mailing address

PO Box 3539
Lake Havasu City, AZ 86405-3539
Phone (928) 453-2727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240808000711 PA Order and Referring Only - Family PracticePractitioner - Family Practice 7618414681

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Heart and Vascular Center PLLC CurrentSince Jul 31, 2023 Accepting new patients
Executive Cardiac Arrhythmia Solutions, Inc PastSince Jul 31, 2023 Accepting new patients

Locations

2082 Mesquite Ave
Ste 100A
Lk Havasu Cty, AZ 86403
Phone (928) 453-2828

Interoperability endpoints

  • Direct secure messaging: abeesetty51395@direct.conemaugh.org
  • FHIR API: https://api.platform.athenahealth.com/3291/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1679254536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3539",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864053539",
            "telephone_number": "928-453-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2082 MESQUITE AVE STE 100A",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036710",
            "telephone_number": "928-453-2727",
            "fax_number": "928-453-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEESETTY",
        "first_name": "ANJU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.