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AGUSTINUS SUHARDJA MD
NPI 1235349473
Radiology - Diagnostic Radiology in Glendora, CA

Active since May 23, 2007PECOS EnrolledAccepts Medicare Assignment
828 S GRAND AVE STE 104, GLENDORA, CA 91740(626) 963-2057(626) 963-4298 Get Directions Write a Review

NPPES record last updated: November 29, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 29, 2021, Jan 8, 2019 (2 updates tracked since 2019).

About Agustinus Suhardja Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGUSTINUS SUHARDJA MD (NPI 1235349473) is an individual diagnostic radiology provider in Glendora, California, licensed in California (A89588) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1995).

NPPES Registry Identity

NPI1235349473
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameAGUSTINUS SUHARDJACredential: MD
Location Address828 S GRAND AVE STE 104Glendora, CA 91740-4856
Mailing AddressPo Box 6869Orange, CA 92863-6869 · (714) 571-5000 · Fax (714) 571-5055
Phone(626) 963-2057
Fax(626) 963-4298
Sole ProprietorNo
Medical School CMSOtherGraduated 1995
Enumeration DateMay 23, 2007
Last NPPES UpdateNovember 29, 20212 updates tracked since enumeration
✔ NPI 1235349473 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Licenses✔ Licensed in CA · A89588✔ Licensed in KS · 04-34805✔ Licensed in MD · D0078407✔ Licensed in VA · 0101256807
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
828 S GRAND AVE STE 104, Glendora, CA 91740
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Agustinus Suhardja Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID941398481
PECOS Enrollment IDI20071115000667
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Agustinus Suhardja reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Southern California Permanente Medical Group
7.7 mi
Health Maintenance Organization
1011 BALDWIN PARK BLVD
Baldwin Park, CA 91706
  • Reassigned Medicare billing, California enrollment
  • Also billed through NPI 1396287082 (California)
  • 13,921 clinicians in this Medicare group
NPI 1770515280 (626) 851-1011
North Oc Imaging Jv, LLC
15 mi
Radiology
15855 POMONA RINCON ROAD, STE 101
Chino Hills, CA 91709
  • Reassigned Medicare billing, California enrollment
  • 10 clinicians in this Medicare group
NPI 1376209940 (714) 578-8882

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

X-ray of chest, 1 view 71045
A chest X-ray, 1 view, is a quick, painless test that produces images of the structures within your chest, such as your heart, lungs, and blood vessels. It helps in diagnosing conditions like pneumonia, heart problems, or lung cancer. You'll stand in front of a machine that emits X-rays, which pass through your body to create the image.
31 services29 patients
Ct scan head or brain without contrast 70450
A CT scan of the head or brain without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your brain, skull, and other structures inside your head. It helps to detect conditions like strokes, tumors, or injuries. No dye (contrast) is used in this test.
14 services14 patients
Ct scan of abdomen and pelvis with contrast 74177
A CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.
14 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91740 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMANATE HEALTH IMAGING
Radiology (Diagnostic Radiology)
828 S GRAND AVE STE 104
GLENDORA, CA 91740
Los Angeles County (626) 963-2057

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Agustinus Suhardja's NPI number?

The NPI number for Agustinus Suhardja is 1235349473. It was assigned to this individual provider in the NPPES registry on May 23, 2007.

Where is Agustinus Suhardja located?

Agustinus Suhardja practices at 828 S Grand Ave Ste 104, Glendora, CA 91740. The listed phone number is (626) 963-2057.

What is Agustinus Suhardja's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Is Agustinus Suhardja enrolled in Medicare?

Yes. Agustinus Suhardja is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Agustinus Suhardja's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Agustinus Suhardja reassigns Medicare benefits to 2 organizations: Southern California Permanente Medical Group (Baldwin Park, CA) and North Oc Imaging Jv, LLC (Chino Hills, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Agustinus Suhardja's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Agustinus Suhardja was last updated on November 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.