NPIMap

Individual provider Active NPI

Satish Jagan Mohan Bankuru, M.D

  • Internal Medicine Physician
  • Coos Bay, OR
National Provider Identifier
1689968943
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD165899 Issued in OR
Practice address
1750 Thompson Rd
Coos Bay, OR 97420-2100
Phone
(541) 269-0333
NPI assigned
Jun 4, 2011
Last updated
Aug 11, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301098724 MI
Internal Medicine Physician 207R00000X MD165899 OR Primary

Addresses

Primary practice location

1750 Thompson Rd
Coos Bay, OR 97420-2100

Mailing address

1750 Thompson Rd
Coos Bay, OR 97420-2100
Phone (541) 269-0333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140812001811 OR Practitioner - Hospitalist 6305063504 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay ClinicGroup PAC ID 9638164874, 13 clinicians

Practice addresses (Care Compare)

1750 Thompson Rd
Coos Bay, OR 97420-2100
Phone (541) 269-0333

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301098724MIMDInternal Medicine Physician
MD165899ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Bend Medical Center Inc CurrentSince Feb 1, 2019 Accepting new patients
Bay Area Hospital District CurrentSince Aug 15, 2014 Accepting new patients
Bay Area Hospital District CurrentSince Aug 15, 2014 Accepting new patients
North Bend Medical Center Inc CurrentSince Feb 1, 2019 Accepting new patients
Bay Clinic CurrentSince Aug 11, 2014 Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

1750 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-0333

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/bea62b1d-5b0c-4c1a-bdbd-eaa129312421/
  • Direct secure messaging: sbankuru124250@secure.stcharleshealthcare.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1307145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1689968943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202100",
            "telephone_number": "541-269-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202100",
            "telephone_number": "541-269-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKURU",
        "first_name": "SATISH",
        "middle_name": "JAGAN MOHAN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-04",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301098724",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD165899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.