NPIMap

Individual provider Active NPI

Shantikumar D. Bedmutha, MD

  • Diagnostic Radiology Physician
  • E Amherst, NY
National Provider Identifier
1881659209
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
147852-1 Issued in NY
Practice address
176 Halston Pkwy
E Amherst, NY 14051-1890
Phone
(716) 636-5877
Fax
(716) 439-6264
NPI assigned
Apr 19, 2006
Last updated
Jul 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X 147852-1 NY
Diagnostic Radiology Physician 2085R0202X 147852-1 NY Primary

Addresses

Primary practice location

176 Halston Pkwy
E Amherst, NY 14051-1890

Mailing address

176 Halston Pkwy
E Amherst, NY 14051-1890
Phone (716) 636-5877

Other identifiers 16

IdentifierTypeStateIssuer
00525091015OtherBLUE SHIELD OF WESTERN NY
10136630OtherFIDELIS
00026885902OtherUNIVERA
01561462MedicaidNY
040426001647OtherFIDELIS
P00003643OtherRAILROAD MEDICARE
300081886OtherRAILROAD MEDICARE
000525091013OtherBLUE SHIELD OF WESTERN NY
300097080OtherRAILROAD MEDICARE
00011395901OtherUNIVERA
000524500002OtherBLUE SHIELD OF WESTERN NY
000525091012OtherBLUE SHIELD OF WESTERN NY
1609861OtherINDEPENDENT HEALTH
P00080950OtherNYMEDICARE RAILROAD
145801FFOtherPREFERRED CARE
R1478521OtherNYWORKERS COMPENSATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
147852-1NYMDNuclear Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northtowns Imaging PC Diagnostic Radiology Past Accepting new patients
Genesee Valley Group Health Association Past Accepting new patients
Northtowns Imaging PC Diagnostic Radiology Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1881659209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 HALSTON PKWY",
            "city": "E AMHERST",
            "state": "NY",
            "postal_code": "140511890",
            "telephone_number": "716-636-5877",
            "fax_number": "716-439-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 HALSTON PKWY",
            "city": "E AMHERST",
            "state": "NY",
            "postal_code": "140511890",
            "telephone_number": "716-636-5877",
            "fax_number": "716-439-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDMUTHA",
        "first_name": "SHANTIKUMAR",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "NY",
            "license": "147852-1",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "147852-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "00525091015",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "10136630",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00026885902",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01561462",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426001647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00003643",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300081886",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000525091013",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300097080",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00011395901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000524500002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000525091012",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "1609861",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00080950",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "145801FF",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "R1478521",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in E Amherst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.