Individual provider Active NPI

Diana Boulos Kneiber, MD

  • Dermatology Physician
  • Santa Clarita, CA
National Provider Identifier
1063973543
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A182437 Issued in CA
Practice address
27235 Tourney Rd Ste 2500
Santa Clarita, CA 91355-5908
Phone
(661) 253-5851
NPI assigned
Mar 27, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A182437 CA Primary

Addresses

Primary practice location

27235 Tourney Rd Ste 2500
Santa Clarita, CA 91355-5908

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707

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
I20230425001234 CA Practitioner - Dermatology 4880928464 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Saint Louis University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Regents of the University of CaliforniaGroup PAC ID 1355248584, 1,426 clinicians

Practice addresses (Care Compare)

2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381

Merit-based Incentive Payment System (MIPS)

Final score
87.51 of 100Reported as group
Quality
79.37
Promoting interoperability
100
Improvement activities
40
Cost
73.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions750
Removal of nail tissue1-10
Removal or shaving of skin growth28
Skin biopsy295

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A182437CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 15, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 15, 2023 Accepting new patients
The Regents of the University of California CurrentSince Sep 1, 2023 Accepting new patients
The Regents of the University of California Internal Medicine CurrentSince Sep 1, 2023 Accepting new patients

Locations

24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252

File 55737
Los Angeles, CA 90074

4733 W Sunset Blvd
Fl 3
Los Angeles, CA 90027
Phone (323) 783-1431

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381

100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500

27235 Tourney Rd
Ste 2500
Valencia, CA 91355
Phone (661) 253-5851

Interoperability endpoints

  • Direct secure messaging: dkneiber1162194@direct.uclahealth.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1063973543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27235 TOURNEY RD STE 2500",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913555908",
            "telephone_number": "661-253-5851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNEIBER",
        "first_name": "DIANA",
        "middle_name": "BOULOS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A182437",
            "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": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Clarita, CA

Sources for this page

Verify at the official NPI Registry.