Organization Active NPI

Bambhania Medical Corporation

  • Internal Medicine Physician
  • Apple Valley, CA
National Provider Identifier
1700194073
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A45672 Issued in CA
Legal business name
BAMBHANIA MEDICAL CORPORATION
Practice address
15962 Quantico Rd
Apple Valley, CA 92307-1302
Phone
(760) 242-0600
Fax
(760) 242-0606
NPI assigned
Sep 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Authorized official

Name
Mrs. Divya Bambhania
Title
Office Manager
Phone
(760) 242-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A45672 CA Primary

Addresses

Primary practice location

15962 Quantico Rd
Apple Valley, CA 92307-1302

Mailing address

PO Box 1139
Victorville, CA 92393-1139
Phone (760) 242-0600

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ37313ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101105001021 CA Part B Supplier - Clinic/Group Practice 6103011911 Receives reassigned benefits from 1 practitioner
Practice locations: Tustin, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1700194073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1139",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923931139",
            "telephone_number": "760-242-0600",
            "fax_number": "760-242-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15962 QUANTICO RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071302",
            "telephone_number": "760-242-0600",
            "fax_number": "760-242-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAMBHANIA MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "BAMBHANIA",
        "authorized_official_first_name": "DIVYA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "760-242-0600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A45672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ37313Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.