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IRAWAN SUSANTO MD NPI 1003836610


NPI Information

NPI: 1003836610
Provider Name: IRAWAN SUSANTO, MD
Classification: Internal Medicine - 207RC0200X
Entity Type: Individual

Specialization: Critical Care Medicine

PECOS Registration: Yes

Address:
1223 16TH ST
SUITE 3400
SANTA MONICA, CA
ZIP 90404
Phone: (310) 449-0939
Get Directions

Irawan Susanto, MD is a critical care medicine internal medicine in Santa Monica, CA with 37 years of experience. The provider is an internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. Irawan Susanto, MD NPI is 1003836610. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Graduation Year:1987

The provider's business location address is:

1223 16TH ST
SUITE 3400
SANTA MONICA, CA
ZIP 90404-217
Phone: (310) 449-0939
Fax: (424) 259-7790

The NPI 1003836610 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Ultrasound guidance for accessing into blood vessel (HCPCS:76937)

The enumeration date for this NPI number is 7/20/2006 and was last updated on 2/6/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RP1001XInternal MedicinePulmonary DiseaseC50280CALIFORNIANo
2207RC0200XInternal MedicineCritical Care MedicineC50280CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1WC50280BMEDICARE PINCALIFORNIA
200C502800MEDICAIDCALIFORNIA
3WC50280AMEDICARE PINCALIFORNIA
4WC50280CMEDICARE PINCALIFORNIA
5D95824MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.