Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Agustinus Suhardja, MD

Individual provider Diagnostic Radiology Physician · NPI 1235349473

Agustinus Suhardja, MD practises Diagnostic Radiology in Glendora, California. Qualified in 1995, 31 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California, Kansas, Maryland and Virginia.

Years since qualifying
31
Licensed in
CA, KS, MD, VA
In the registry since
2007
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

828 S Grand Ave Ste 104
Glendora, CA 91740-4856
Phone: (626) 963-2057
Fax: (626) 963-4298
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence A89588 (CA)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 04-34805 (KS)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence D0078407 (MD)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 0101256807 (VA)

Record details

NPI number1235349473
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 23, 2007
Last updated in NPPESNovember 29, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients117
Services billed 158 a service is one billed item, such as a visit, a test or a procedure
Average patient age70

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Southern California Permanente Medical Group

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 11242 clinicians in the practice; 12 are shown here.

Other providers in Glendora