Agustinus Suhardja, MD - Medicare Diagnostic Radiology in Glendora, CA

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Agustinus Suhardja, MD is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Glendora, California. He graduated from medical school in 1995 and has 30 years of diverse experience with area of expertise as Diagnostic Radiology. He is a member of the group practice Southern California Permanente Medical Group and his current practice location is 828 S Grand Ave Ste 104, Glendora, California. You can reach out to his office (for appointments etc.) via phone at (626) 963-2057.

Agustinus Suhardja is licensed to practice in California (license number A89588) 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 1235349473.

Contact Information

Agustinus Suhardja, MD
828 S Grand Ave Ste 104,
Glendora, CA 91740-4856
(626) 963-2057
(626) 963-4298

Map and Direction




Physician's Profile

Full NameAgustinus Suhardja
GenderMale
SpecialityDiagnostic Radiology
Experience30 Years
Location828 S Grand Ave Ste 104, Glendora, California
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Agustinus Suhardja graduated from medical school in 1995
  NPI Data:
  • NPI Number: 1235349473
  • Provider Enumeration Date: 05/23/2007
  • Last Update Date: 11/29/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 0941398481
  • Enrollment ID: I20071115000667

Medical Identifiers

Medical identifiers for Agustinus Suhardja such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1235349473NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology 04-34805 (Kansas)Secondary
2085R0202XRadiology - Diagnostic Radiology D0078407 (Maryland)Secondary
2085R0202XRadiology - Diagnostic Radiology 0101256807 (Virginia)Secondary
2085R0202XRadiology - Diagnostic Radiology A89588 (California)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Kaiser Foundation Hospital - DowneyDowney, CAHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Southern California Permanente Medical Group60027291758172

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. Agustinus Suhardja allows following entities to bill medicare on his behalf.
Entity NameSouthern California Permanente Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1770515280
PECOS PAC ID: 6002729175
Enrollment ID: O20031110000678
Entity NameSt Jude Radiology Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1649349705
PECOS PAC ID: 7214838002
Enrollment ID: O20040115000501
Entity NameSouthern California Permanente Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1316979834
PECOS PAC ID: 6002729175
Enrollment ID: O20040126000823
Entity NameGlendora Radiological Assoc Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992797070
PECOS PAC ID: 2163514589
Enrollment ID: O20070815000331
Entity NameEmanate Health Imaging
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093240004
PECOS PAC ID: 4284991472
Enrollment ID: O20171122002766
Entity NameNorth Oc Imaging Jv, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1376209940
PECOS PAC ID: 6204229529
Enrollment ID: O20220401001471

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. Agustinus Suhardja 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 AddressPractice Location Address
Agustinus Suhardja, MD
Po Box 6869,
Orange, CA 92863-6869

Ph: (714) 571-5000		Agustinus Suhardja, MD
828 S Grand Ave Ste 104,
Glendora, CA 91740-4856

Ph: (626) 963-2057

Reviews and Comments


Radiology Doctors in Glendora, CA


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Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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