Kimberly Fanning-Shiles, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

98512 Issued in CA

Practice address

7365 Carnelian St
Ste. 202
Rancho Cucamonga, CA 91730-1158

Phone

(909) 376-5125

NPI assigned

Apr 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.fanningshiles.p1@direct.sokya.nextgenshare.com

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.

• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Marriage & Family Therapist

  Medicare reassignment Care Compare group NPD
• Sokyahealth Medical Group PC

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1942970330
  Medicare reassignment NPD

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1063867737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7365 CARNELIAN ST",
            "address_2": "STE. 202",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301158",
            "telephone_number": "909-376-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7365 CARNELIAN ST",
            "address_2": "STE. 202",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301158",
            "telephone_number": "909-376-5125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "517 N Mountain Ave Ste 129",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917865016",
            "country_code": "US",
            "telephone_number": "909-376-5125",
            "fax_number": "909-578-0369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANNING-SHILES",
        "first_name": "KIMBERLY",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-29",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF 80277",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "98512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie Lynn Fanelli, LCSW
• John Fang, L.AC.
• Kevin Fang, DMD
• Stephanie Fang
• Jennifer Fannin
• Samy Saad Farag, PHARMACIST
• Rita Farfan, RBT
• Sandy Farg
• Mackensey Farina
• Tehmina Fasih, DDS

• Marriage & Family Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.