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BUDI WIRYAWAN MD
NPI 1609961739
Pediatrics - Pediatric Critical Care Medicine in Palo Alto, CA

Active since October 04, 2006PECOS Enrolled
725 WELCH RD, PALO ALTO, CA 94304(650) 497-8000 Get Directions Write a Review

NPPES record last updated: April 16, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Budi Wiryawan Md NPPES

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

BUDI WIRYAWAN MD (NPI 1609961739) is an individual pediatric critical care medicine provider in Palo Alto, California, licensed in California (C136504) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Mesa.

NPPES Registry Identity

NPI1609961739
Entity TypeIndividualMale
Primary Taxonomy2080P0203X
Provider Legal NameBUDI WIRYAWANCredential: MD
Location Address725 WELCH RDPalo Alto, CA 94304-1601
Mailing Address725 Welch RdPalo Alto, CA 94304-1601 · (650) 497-8000
Phone(650) 497-8000
Sole ProprietorNo
Enumeration DateOctober 4, 2006
Last NPPES UpdateApril 16, 2024
NPPES CertifiedApril 16, 2024
✔ NPI 1609961739 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Critical Care MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080P0203X
Licenses✔ Licensed in CA · C136504✔ Licensed in AZ · 37457✔ Licensed in NY · 001976
Definition
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
Also ListedPediatricsTaxonomy 208000000X · License C136504 (CA)
725 WELCH RD, Palo Alto, CA 94304
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Secondary Practice Location 1

Location 11400 S Dobson Rd, Banner Children's HospitalMesa, AZ 85202-4707 · Phone (480) 512-6274 · Fax (480) 512-3028

Other Identifiers 1

Medicaid02461374NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Budi Wiryawan 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.

Medicare Billing Reassignment

Medicare enrollment records show Budi Wiryawan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Lpch Medical Group Div Of Lucile
Same address
Children
725 WELCH RD
Palo Alto, CA 94304
  • Reassigned Medicare billing, California enrollment
  • 3,617 clinicians in this Medicare group
NPI 1417907940 (650) 498-6762

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

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.

EIRI INENAGA MS, OTR/L
Occupational Therapist (Pediatrics)
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8218
WENDY LEIGH ADAMS ARNP
Nurse Practitioner (Neonatal)
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
KEVIN WEI-HAN CHI MD
Pediatrics
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
ASHEEN RAMA MD
Anesthesiology (Pediatric Anesthesiology)
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
CRYSTAL LEE MACKALL MD
Pediatrics (Pediatric Hematology-Oncology)
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
KRISTI LYNNE O'CONNOR OT
Occupational Therapist
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
LAUREN GENNA ROOS NP
Nurse Practitioner
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000
SHALINI MITTAL MD
Hospitalist
725 WELCH RD
PALO ALTO, CA 94304
Santa Clara County (650) 497-8000

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 Budi Wiryawan's NPI number?

The NPI number for Budi Wiryawan is 1609961739. It was assigned to this individual provider in the NPPES registry on October 4, 2006.

Where is Budi Wiryawan located?

Budi Wiryawan practices at 725 Welch Rd, Palo Alto, CA 94304. The listed phone number is (650) 497-8000.

What is Budi Wiryawan's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Critical Care Medicine, with taxonomy code 2080P0203X.

Is Budi Wiryawan enrolled in Medicare?

Yes. Budi Wiryawan is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Budi Wiryawan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Budi Wiryawan reassigns Medicare benefits to Lpch Medical Group Div Of Lucile (Palo Alto, CA). The 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 Budi Wiryawan'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 Budi Wiryawan was last updated on April 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.