Individual provider Active NPI

Nasser T Liasi, MD

  • Internal Medicine Physician
  • Fontana, CA
National Provider Identifier
1144466780
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A115058 Issued in CA
Practice address
8110 Mango Ave
Fontana, CA 92335-3603
Phone
(909) 427-1303
NPI assigned
Jan 4, 2009
Last updated
Oct 4, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A115058 CA Primary

Addresses

Primary practice location

8110 Mango Ave
Fontana, CA 92335-3603

Mailing address

PO Box 12209
San Bernardino, CA 92423-2209
Phone (909) 427-1303

Other practice location 1

2 West Fern Avenue
Redlands, CA 92373-5916
Phone (909) 793-3311

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
I20111005000259 CA Practitioner - Internal Medicine 5092987586 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinic Services of California Medical Group IncGroup PAC ID 7810209715, 65 clinicians

Practice addresses (Care Compare)

1499 E Highland Ave
San Bernardino, CA 92404-4611
Phone (855) 422-8029

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A115058CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Medical Group, Inc Internal Medicine CurrentSince Nov 1, 2018 Accepting new patients
Pinnacle Medical Group, Inc Internal Medicine CurrentSince Nov 1, 2018 Accepting new patients
Quantum Healthcare Medical Associates Inc. Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Clinic Services of California Medical Group Inc CurrentSince Jan 1, 2022 Accepting new patients

Locations

400 N Pepper Ave
Colton, CA 92324
Phone (909) 580-1400

8110 Mango Ave
Fontana, CA 92335
Phone (909) 427-1303

10431 Lemon Ave
Ste N
Rch Cucamonga, CA 91737
Phone (909) 466-6579

1499 E Highland Ave
Sn Bernrdno, CA 92404
Phone (855) 422-8029

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1231027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1144466780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12209",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924232209",
            "telephone_number": "909-427-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8110 MANGO AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353603",
            "telephone_number": "909-427-1303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 West Fern Avenue",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923735916",
            "country_code": "US",
            "telephone_number": "909-793-3311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIASI",
        "first_name": "NASSER",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-04",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A115058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.