Active NPI
Andrew Jeremy Darmahkasih, MD
- Pediatrics Physician
- Pasadena, CA
National Provider Identifier
1841793619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A164751
- Practice address
- 800 Fairmount Ave Ste 310
Pasadena, CA 91105-3153 - Phone
- (626) 449-7350
- Fax
- (626) 449-1321
- NPI assigned
- Mar 17, 2018
- Last updated
- Jul 12, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A164751 | CA | Primary |
Addresses
Primary practice location
800 Fairmount Ave Ste 310
Pasadena, CA 91105-3153
Mailing address
800 Fairmount Ave Ste 310
Pasadena, CA 91105-3153
Phone (626) 449-7350
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200421002778 | CA | Order and Referring Only - Pediatric Medicine | 4981034626 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A164751 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1841793619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 FAIRMOUNT AVE STE 310",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053153",
"telephone_number": "626-449-7350",
"fax_number": "626-449-1321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 FAIRMOUNT AVE STE 310",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053153",
"telephone_number": "626-449-7350",
"fax_number": "626-449-1321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DARMAHKASIH",
"first_name": "ANDREW",
"middle_name": "JEREMY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-17",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A164751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.