Individual provider Active NPI

Nooshin Salehi, MD

  • Internal Medicine Physician
  • San Bernardino, CA
National Provider Identifier
1053802470
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A176954 Issued in CA
Practice address
565 N Mount Vernon Ave
San Bernardino, CA 92411-2661
Phone
(909) 884-9091
Fax
(909) 383-7013
NPI assigned
May 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A176954 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

565 N Mount Vernon Ave
San Bernardino, CA 92411-2661

Mailing address

5425 La Grande
Yorba Linda, CA 92887-4010

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
I20220525002215 CA Practitioner - Internal Medicine 7810375235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lasalle Medical AssociatesGroup PAC ID 1557301744, 4 clinicians

Practice addresses (Care Compare)

565 N Mount Vernon Ave
San Bernardino, CA 92411-2661
Phone 90988490911540

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A176954CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lasalle Medical Associates CurrentSince Apr 19, 2022 Accepting new patients
Lasalle Medical Associates Current Accepting new patients
Lasalle Medical Associates CurrentSince Apr 19, 2022 Accepting new patients

Locations

17577 Arrow Blvd
Fontana, CA 92335
Phone (909) 823-4454

565 N Mount Vernon Ave
Sn Bernrdno, CA 92411
Phone (909) 884-9091

685 Carnegie Dr
Ste 230
Sn Bernrdno, CA 92408
Phone (909) 890-0407

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1053802470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5425 LA GRANDE",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928874010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 N MOUNT VERNON AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112661",
            "telephone_number": "909-884-9091",
            "fax_number": "909-383-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALEHI",
        "first_name": "NOOSHIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A176954",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.