Individual provider Active NPI

Harry Kallas, M.D.

  • Pediatric Critical Care Medicine Physician
  • Fresno, CA
National Provider Identifier
1134214901
Registry record updated Jul 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
G81209 Issued in CA
Practice address
6235 N Fresno St
Suite # 103
Fresno, CA 93710-5269
Phone
(559) 449-4350
Fax
(559) 449-4358
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X G81209 CA Primary

Addresses

Primary practice location

6235 N Fresno St
Suite # 103
Fresno, CA 93710-5269

Mailing address

6235 N Fresno St
Suite # 103
Fresno, CA 93710-5269
Phone (559) 449-4350

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ71868ZMedicaidCA

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
I20041202000455 CA Practitioner - Pediatric Medicine 6204892193 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G81209CAMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Anesthesia Associates Medical Group Inc Pediatric Critical Care Medicine CurrentSince Apr 1, 2014 Accepting new patients
Valley Children'S Medical Group Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

6235 N Fresno St
Fresno, CA 93710
Phone (559) 229-3668

6235 N Fresno St
Ste 103
Fresno, CA 93710
Phone (559) 449-4350

9300 Valley Childrens Pl
#63
Madera, CA 93636
Phone (559) 353-5542

9300 Valley Childrens Pl
Madera, CA 93636
Phone (559) 353-5700

9300 Valley Childrens Pl
Ste FE10
Madera, CA 93636

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406246400000",
    "number": "1134214901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6235 N FRESNO ST",
            "address_2": "SUITE # 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105269",
            "telephone_number": "559-449-4350",
            "fax_number": "559-449-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6235 N FRESNO ST",
            "address_2": "SUITE # 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105269",
            "telephone_number": "559-449-4350",
            "fax_number": "559-449-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAS",
        "first_name": "HARRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2014-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "G81209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ71868Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.