NPIMap

Individual provider Active NPI

Adel Sandouk, M.D.

  • Pulmonary Disease Physician
  • Glendora, CA
National Provider Identifier
1043315575
Registry record updated Jan 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A86608 Issued in CA
Practice address
210 S Grand Ave Ste 307
Glendora, CA 91741-4278
Phone
(626) 914-2900
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X A86608 CA Primary

Addresses

Primary practice location

210 S Grand Ave Ste 307
Glendora, CA 91741-4278

Mailing address

PO Box 122
Glendora, CA 91740-0122
Phone (626) 914-2900

Other practice location 1

210 S Grand Ave
207
Glendora, CA 91741-4205
Phone (626) 914-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050614000775 CA Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 8325082043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

210 S Grand Ave
Suite 307
Glendora, CA 91741-4278
Phone (626) 914-2900

Hospital & facility affiliations

  • Emanate Health Foothill Presbyterian Hospital Hospital, Glendora, CA, CCN 050597
  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
  • San Dimas Community Hospital Hospital, San Dimas, CA, CCN 050588
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A86608CAMDPulmonary Disease Physician

Practice roles (7 of 8)

OrganizationSpecialtyStatusNew patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Chest Diseases Associates PC Pulmonary Disease Past Accepting new patients
Emanate Health Foothill Presbyterian Hospital Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Edwin Oghoorian, DPM, Inc. PastSince Apr 15, 2007 Accepting new patients
Emanate Health Medical Center Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578787200000",
    "number": "1043315575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917400122",
            "telephone_number": "626-914-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S GRAND AVE STE 307",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414278",
            "telephone_number": "626-914-2900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 S Grand Ave",
            "address_2": "207",
            "address_purpose": "LOCATION",
            "city": "Glendora",
            "state": "CA",
            "postal_code": "917414205",
            "country_code": "US",
            "telephone_number": "626-914-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOUK",
        "first_name": "ADEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-01-12",
        "certification_date": "2020-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A86608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.