Sampath Kumar Suryadevara, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C50601 Issued in CA

Practice address

1771 W Romneya Dr C
Anaheim, CA 92801-1817

Phone

(714) 520-3000

Fax

(714) 520-5742

NPI assigned

Mar 25, 2007

Last updated

Dec 16, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1174780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1932226750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 W ROMNEYA DR C",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011817",
            "telephone_number": "714-520-3000",
            "fax_number": "714-520-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 W ROMNEYA DR C",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011817",
            "telephone_number": "714-520-3000",
            "fax_number": "714-520-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURYADEVARA",
        "first_name": "SAMPATH",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-25",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C50601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.