Individual provider Active NPI

Gamil Fteeh, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • San Bernardino, CA
National Provider Identifier
1053543165
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
A130028 Issued in CA
Practice address
250 E Caroline St Ste J
San Bernardino, CA 92408-3758
Phone
(909) 835-1810
Fax
(909) 835-1780
NPI assigned
Aug 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X A130028 CA Primary

Addresses

Primary practice location

250 E Caroline St Ste J
San Bernardino, CA 92408-3758

Mailing address

393 E Walnut St
Pasadena, CA 91188-0001
Phone (909) 558-8242

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150612000841 CA Practitioner - Other (Physician)Practitioner - Pediatric MedicinePractitioner - Neurology 8729399043 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A130028CAMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 20, 2021 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jul 1, 2015 Accepting new patients
Sac Health System CurrentSince Jul 6, 2017 Accepting new patients
Sac Health System Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 20, 2021 Accepting new patients
Sac Health System CurrentSince Jul 6, 2017 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

82934 Civic Center Dr
Indio, CA 92201
Phone (760) 477-0733

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

250 E Caroline St
Ste J
San Bernardino, CA 92408
Phone (909) 651-1900

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1250985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1053543165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "909-558-8242",
            "fax_number": "909-558-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E CAROLINE ST STE J",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083758",
            "telephone_number": "909-835-1810",
            "fax_number": "909-835-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FTEEH",
        "first_name": "GAMIL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-23",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "CA",
            "license": "A130028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.