NPIMap

Individual provider Active NPI

Cynthia Diane Moreno, D.O.

  • Family Medicine Physician
  • Chino, CA
National Provider Identifier
1053394817
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A 8031 Issued in CA
Practice address
15361 Central Ave
Chino, CA 91710-7608
Phone
(909) 363-7171
Fax
(909) 363-7676
NPI assigned
Nov 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A 8031 CA Primary

Addresses

Primary practice location

15361 Central Ave
Chino, CA 91710-7608

Mailing address

15361 Central Ave
Chino, CA 91710-7608
Phone (909) 363-7171

Other identifiers 1

IdentifierTypeStateIssuer
00AX83110MedicaidCA

Other names 1

  • Dr. Cynthia Diane Benton Other name

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
I20040316001434 CA Practitioner - Family Practice 6305736117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 2000
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

15361 Central Ave
Chino, CA 91710-7608
Phone (909) 393-7171

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A 8031CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moreno Family Medical and Associates Inc Family Medicine CurrentSince Jan 14, 2015 Accepting new patients
California Care Level Management Direct Medical Group, Inc PastSince Jun 26, 2006 Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Primecare Medical Group Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

15361 Central Ave
Chino, CA 91710
Phone (909) 393-7171

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BCJICA/Endpoint/BCJICA

Organizations & group practices 5

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 3

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": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1053394817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15361 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917107608",
            "telephone_number": "909-363-7171",
            "fax_number": "909-363-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15361 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917107608",
            "telephone_number": "909-363-7171",
            "fax_number": "909-363-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "CYNTHIA",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-25",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A 8031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX83110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "BENTON",
            "middle_name": "DIANE",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.