San Bernardino Foot Clinic, Inc.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E4416 Issued in CA

Legal business name

SAN BERNARDINO FOOT CLINIC, INC.

Practice address

2095 N Waterman Ave
San Bernardino, CA 92404-4834

Phone

(909) 882-3800

Fax

(909) 882-3380

NPI assigned

Jul 6, 2006

Last updated

Feb 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maria Cuevas

Title

Office Manager

Phone

(909) 882-3800

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sang Dae Lee, DPM

  • Foot & Ankle Surgery Podiatrist
  • San Bernardino, CA
  • NPI 1780694356
  Medicare reassignment NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1154352037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044834",
            "telephone_number": "909-882-3800",
            "fax_number": "909-882-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044834",
            "telephone_number": "909-882-3800",
            "fax_number": "909-882-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BERNARDINO FOOT CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "CUEVAS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-882-3800"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0253335",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "DD297Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E44161",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CI863B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Bernardino County Superintendent of Schools
• San Bernardino County/CCS
• San Bernardino Department of Public Health
• San Bernardino Family Medical Services Inc (San Bernardino Family Medical Clinic)
• San Bernardino Fire Department
• San Bernardino Hospice and Palliative Care
• San Bernardino Hospice Care, Inc.
• San Bernardino Hospice Nurses
• San Bernardino Imaging LLC (Computerized Diagnostic Imaging Centers - San Bernardino)
• San Bernardino Medical Clinic Inc

• Foot & Ankle Surgery Podiatrist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; 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.