Individual provider Active NPI

Jonathan Balakumar, M.D.

  • Emergency Medicine Physician
  • Miami, FL
National Provider Identifier
1710340948
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A157935 Issued in CA
Practice address
1611 NW 12TH Ave
Emergency Medicine Department
Miami, FL 33136-1005
Phone
(305) 585-1111
NPI assigned
Apr 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME136185 FL
Emergency Medicine Physician 207P00000X A157935 CA Primary

Addresses

Primary practice location

1611 NW 12TH Ave
Emergency Medicine Department
Miami, FL 33136-1005

Mailing address

1611 NW 12TH Ave
Miami, FL 33136-1005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20190912001583 CA Practitioner - Emergency Medicine 7719216944 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, Geffen School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Andy Shen MD IncGroup PAC ID 8527164482, 22 clinicians

Practice addresses (Care Compare)

100 S Raymond Ave
Alhambra, CA 91801-3166
Phone (626) 570-1606

Hospital & facility affiliations

  • Alhambra Hospital Medical Center Hospital, Alhambra, CA, CCN 050281

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A157935CAMDEmergency Medicine Physician
ME136185FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California Emergency Medicine CurrentSince Jul 10, 2019 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jul 10, 2019 Accepting new patients
Andy Shen, M.D., Inc. Emergency Medicine CurrentSince May 1, 2021 Accepting new patients
Team Physicians of Southern California Medical Group, Inc. Emergency Medicine CurrentSince Jan 1, 2025 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients

Locations

100 S Raymond Ave
Alhambra, CA 91801
Phone (626) 457-7938

751 Medical Center Ct
#1182
Chula Vista, CA 91911

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1420 S Central Ave
Glendale, CA 91204
Phone (818) 502-1900

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4002 Vista Way
Oceanside, CA 92056
Phone (760) 724-8411

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

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.

Hospital & facility affiliations 1

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": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1710340948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005",
            "telephone_number": "305-585-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALAKUMAR",
        "first_name": "JONATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-04",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME136185",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A157935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.