Gautam Vangipuram, M.D
Individual provider Active NPI Retina Specialist (Ophthalmology) Physician · Pasadena, CA
NPI 1780052233 · NPPES record last updated Jan 10, 2022
Key facts
- NPI
- 1780052233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Retina Specialist (Ophthalmology) Physician 207WX0107X
- License
- C173301 (CA)
- Practice address
- 2619 E Colorado Blvd Ste 150
Pasadena, CA 91107-3747 - Phone
- (626) 793-4168
- Fax
- (626) 793-6256
- NPI assigned
- Sep 14, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Ophthalmology
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aarchan Joshi, M.D. Inc
Practice addresses (Care Compare)
10861 Cherry St
Suite 204
Los Alamitos, CA 90720-5403
Phone (562) 598-2020
555 Pier Ave
Suite D
Hermosa Beach, CA 90254-3801
Phone (815) 342-1739
Hospital & facility affiliations
- Torrance Memorial Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211029000238 | CA | Practitioner - Ophthalmology | 2961737721 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019018140 | MO | MD | Ophthalmology Physician |
| C173301 | CA | MD | Retina Specialist (Ophthalmology) Physician |
Practice roles (8 of 9)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aarchan Joshi, M.D. Inc | Ophthalmology | Current |
Accepting new patients |
| Retina Consultants of Orange County, a Medical Corporation | Retina Specialist | Current |
Accepting new patients |
| Gautam Vangipuram MD Inc | Retina Specialist | Current |
Accepting new patients |
| Azul Vision Inc. | Ophthalmology | Past | Accepting new patients |
| The Retina Institute LLC | Ophthalmology | Past |
Accepting new patients |
| Hermann Area Hospital District | Past | Accepting new patients | |
| Hecht Eye Institute Inc | Ophthalmology | Past | Accepting new patients |
| Riverside Eye Partners a Professional Medical Corporation | Past |
Accepting new patients |
Locations
301 W Bastanchury Rd
Ste 285
Fullerton, CA 92835
Phone 7147384620 ext. 212
555 Pier Ave
Ste D
Hermosa Beach, CA 90254
Phone (815) 342-1739
3900 Long Beach Blvd
Long Beach, CA 90807
Phone (562) 431-7345
10861 Cherry St
Ste 204
Los Alamitos, CA 90720
Phone (562) 598-2020
520 N Prospect Ave
Ste 206
Redondo Beach, CA 90277
Phone (310) 376-8850
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/f62890b5-77ff-44bd-a981-0a0981047b35/
- gvangipuram@bcr.intellechartdirect.net
- gautam.vangipuram.p1@direct.atlantiseyecare.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 2019018140 | MO | |
| Retina Specialist (Ophthalmology) Physician | 207WX0107X | 2019018140 | MO | |
| Retina Specialist (Ophthalmology) Physician | 207WX0107X | C173301 | CA | Yes |
Addresses
Primary practice location
2619 E Colorado Blvd Ste 150
Pasadena, CA 91107-3747
Mailing address
1900 W Garvey Ave S Unit 335
West Covina, CA 91790-2656
Phone (626) 305-9100
Other providers in Pasadena, CA
- John Joseph Vandyke
- Heather Vanegas
- Vanessa a. Isiaka, M.D., Inc.
- Joshua Vang
- John S Vangerov
- Lauren Vanorsdale
- Frederick Vaquer
- Clara Vara Escamilla
- Gita Aanjalie Varaprasathan
- Varda Home Inc
All providers in Pasadena, CA · Retina Specialist (Ophthalmology) Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.