Dr Mudjianto Chandra, MD is a medicare enrolled "Colon & Rectal Surgery" physician in Tarzana, California. He graduated from medical school in 1983 and has 41 years of diverse experience with area of expertise as General Surgery. His current practice location is
18370 Burbank Blvd, Suite 607, Tarzana, California. You can reach out to his office (for appointments etc.) via phone at
(818) 709-8161.
Dr Mudjianto Chandra is licensed to practice in California (license number A52198) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1225152515.
Physician's Profile
| Full Name | Dr Mudjianto Chandra |
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| Gender | Male |
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| Speciality | General Surgery |
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| Experience | 41 Years |
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| Location | 18370 Burbank Blvd, Tarzana, California |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Mudjianto Chandra graduated from medical school in 1983
NPI Data:
- NPI Number: 1225152515
- Provider Enumeration Date: 03/19/2007
- Last Update Date: 07/09/2007
Medicare PECOS Information:
- PECOS PAC ID: 6305826876
- Enrollment ID: I20040723001029
Medical Identifiers
Medical identifiers for Dr Mudjianto Chandra such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1225152515 | NPI | - | NPPES |
| 00A521980 | Other | CA | BLUE SHIELD |
| A52198 | Other | | OTHER |
| A52198 | Other | | TRICARE |
| P92709600 | Other | | OXFORD |
| A52198 | Other | CA | BLUE CROSS |
| 00A521980 | Medicaid | CA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208600000X | Surgery | A52198 (California) | Primary |
| 208C00000X | Colon & Rectal Surgery | A52198 (California) | Primary |
Medical Facilities Affiliation
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mudjianto Chandra allows following entities to bill medicare on his behalf.
| Entity Name | Mudjianto Chandra, M.d., Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083658827
PECOS PAC ID: 4880825165
Enrollment ID: O20140331000797 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mudjianto Chandra is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Mudjianto Chandra, MD
18370 Burbank Blvd, Suite 607,
Tarzana, CA 91356-2804
Ph: (818) 709-8161 | Dr Mudjianto Chandra, MD
18370 Burbank Blvd, Suite 607,
Tarzana, CA 91356-2804
Ph: (818) 709-8161 |
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