Individual provider Active NPI

Ann Denise Bendroff, MA CCC SLP

  • Speech-Language Pathologist
  • Riverside, CA
National Provider Identifier
1063634913
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP 6333 Issued in CA
Practice address
10800 Magnolia Ave
Riverside, CA 92505-3043
Phone
(951) 353-4759
Fax
(951) 353-5056
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP 6333 CA Primary

Addresses

Primary practice location

10800 Magnolia Ave
Riverside, CA 92505-3043

Mailing address

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-4759

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100505000744 CA Practitioner - Qualified Speech Language Pathologist 6709914245 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6333CAMDOccupational Therapy Assistant
SP 6333CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jul 1, 2009 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 1, 2009 Accepting new patients

Locations

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

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

Organizations & group practices 2

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1063634913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "951-353-4759",
            "fax_number": "951-353-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "951-353-4759",
            "fax_number": "951-353-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENDROFF",
        "first_name": "ANN",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "MA CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP 6333",
            "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": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.