Active NPI
Agustinus Rushanaedy, MD
- Urology Physician
- Bakersfield, CA
National Provider Identifier
1679683742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- A41710
- Practice address
- 6001 Truxtun Ave
Suite 220
Bakersfield, CA 93309-0679 - Phone
- (661) 323-6660
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | OR MD 14298 | OR | |
| Urology Physician | 208800000X | MD 00033485 | WA | |
| Urology Physician | 208800000X | A41710 | CA | Primary |
| Urology Physician | 208800000X | MD 10824 | HI |
Addresses
Primary practice location
6001 Truxtun Ave
Suite 220
Bakersfield, CA 93309-0679
Mailing address
PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 865-3700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A41710 | CA | MD | Urology Physician |
| MD 10824 | HI | MD | Urology Physician |
| OR MD 14298 | OR | MD | Urology Physician |
| MD 00033485 | WA | MD | Urology Physician |
| 41710 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Communities Physician Network, Inc. | Past | Accepting new patients |
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.
-
- Health Maintenance Organization
- San Luis Obispo, CA
- NPI 1275735011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1679683742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31309",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900310309",
"telephone_number": "323-865-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6001 TRUXTUN AVE",
"address_2": "SUITE 220",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933090679",
"telephone_number": "661-323-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSHANAEDY",
"first_name": "AGUSTINUS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "OR",
"license": "OR MD 14298",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "WA",
"license": "MD 00033485",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "A41710",
"primary": true
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "HI",
"license": "MD 10824",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.