ANGELINE HADIWIDJAJA MD
NPI 1417049792
Pediatrics in Fremont, CA

Q: What is Angeline Hadiwidjaja's NPI number?

The NPI number for Angeline Hadiwidjaja is 1417049792. It was assigned to this individual provider in the NPPES registry on September 28, 2006.

Q: What is Angeline Hadiwidjaja's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since September 28, 2006PECOS Enrolled

3200 KEARNEY ST, FREMONT, CA 94538(510) 490-1222 Get Directions Write a Review

NPPES record last updated: May 14, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Angeline Hadiwidjaja Md NPPES

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

ANGELINE HADIWIDJAJA MD (NPI 1417049792) is an individual pediatrics provider in Fremont, California, licensed in California (A67186) and active in the NPI registry since September 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417049792

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameANGELINE HADIWIDJAJACredential: MD

Location Address3200 KEARNEY STFremont, CA 94538-2299

Mailing Address325 Distel CirLos Altos, CA 94022-1408

Phone(510) 490-1222

Sole ProprietorNo

Enumeration DateSeptember 28, 2006

Last NPPES UpdateMay 14, 2020

NPPES CertifiedMay 14, 2020

✔ NPI 1417049792 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in CA · A67186

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

3200 KEARNEY ST, Fremont, CA 94538

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Angeline Hadiwidjaja Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94538 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

$104.51 typical visit price

range $69.00 – $202.35

Typical copayment $26.12 (range $17.25 – $50.58)

Most-billed visit code 99203

Established Patient

$119.48 typical visit price

range $23.44 – $166.46

Typical copayment $29.87 (range $5.86 – $41.61)

Most-billed visit code 99214

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 20

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

DR. LAKSHMI SRINIVASAN MD

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