AUDREYANDRA LUCIA IMANSJAH DO - NPI 1710481858 - Family Medicine in San Ramon, CA

Q: What is Audreyandra Imansjah's NPI number?

The NPI number for Audreyandra Imansjah is 1710481858. It was assigned to this individual provider in the NPPES registry on March 22, 2018.

Q: What is Audreyandra Imansjah's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About Audreyandra Lucia Imansjah Do NPPES

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

AUDREYANDRA LUCIA IMANSJAH DO (NPI 1710481858) is an individual family medicine provider in San Ramon, California, licensed in California (17597) and active in the NPI registry since March 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1710481858

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameAUDREYANDRA LUCIA IMANSJAHCredential: DO

Location Address2300 CAMINO RAMONSan Ramon, CA 94583-1354

Mailing Address2300 Camino RamonSan Ramon, CA 94583-1354 · (925) 244-7400

Phone(925) 244-7400

Sole ProprietorYes

Medical School CMSOtherGraduated 2018

Enumeration DateMarch 22, 2018

Last NPPES UpdateApril 21, 20223 updates tracked since enumeration

NPPES CertifiedApril 21, 2022

✔ NPI 1710481858 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in CA · 17597

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2300 CAMINO RAMON, San Ramon, CA 94583

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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 and accepts Medicare assignment

Audreyandra Lucia Imansjah Do 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 ID749603504

PECOS Enrollment IDI20220617002155

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 94583 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 11

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

JASON LOUIE PHARM.D.

Pharmacist