NPIMap

Individual provider Active NPI

Raghu Nandan, M.D

  • Hematology & Oncology Physician
  • Lakewood, CA
National Provider Identifier
1861463606
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A51197 Issued in CA
Practice address
3650 South St
212
Lakewood, CA 90712-1502
Phone
(562) 272-7630
Fax
(562) 272-7631
NPI assigned
Jan 30, 2006
Last updated
Mar 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X A51197 CA Primary

Addresses

Primary practice location

3650 South St
212
Lakewood, CA 90712-1502

Mailing address

3650 South St
212
Lakewood, CA 90712-1502
Phone (562) 272-7630

Other names 1

  • Raghu Thiruvengadam Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20081029000325 CA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2466345335 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3650 S St
Suite 212
Lakewood, CA 90712-1528
Phone (562) 299-5200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
38.53 of 100Reported as group
Quality
20.07
Promoting interoperability
0
Improvement activities
0
Cost
75.03

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A51197CAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Current Accepting new patients
R. Nandan, M.D., Inc Current Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Dec 1, 2024 Accepting new patients
University of California Irvine Past Accepting new patients
CHLB, LLC Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients

Locations

3650 South St
Ste 212
Lakewood, CA 90712
Phone (562) 272-7630

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 9

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1861463606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 SOUTH ST",
            "address_2": "212",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121502",
            "telephone_number": "562-272-7630",
            "fax_number": "562-272-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 SOUTH ST",
            "address_2": "212",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121502",
            "telephone_number": "562-272-7630",
            "fax_number": "562-272-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANDAN",
        "first_name": "RAGHU",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A51197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAGHU",
            "last_name": "THIRUVENGADAM",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lakewood, CA

Sources for this page

Verify at the official NPI Registry.