NPIMap

Individual provider Active NPI

Mohammad S Kanakriyeh, MD

  • Pediatric Cardiology Physician
  • San Bernardino, CA
National Provider Identifier
1164512281
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
A42526 Issued in CA
Practice address
350 E Vanderbilt Way
Ste a
San Bernardino, CA 92408
Phone
(909) 886-5200
Fax
(909) 382-9017
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X A42526 CA Primary

Addresses

Primary practice location

350 E Vanderbilt Way
Ste a
San Bernardino, CA 92408

Mailing address

350 E Vanderbilt Way
Ste a
San Bernardino, CA 92408
Phone (909) 886-5200

Other identifiers 3

IdentifierTypeStateIssuer
330698865OtherCABLUE CROSS
00A425260MedicaidCA
ZZZ51351ZOtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141029002073 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 3072734300 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A42526CAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Redlands Community Hospital Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
Dignity Health Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
St. Mary Medical Center Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Diagnostic Imaging Services Past Accepting new patients
Dignity Health Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1164512281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 E VANDERBILT WAY",
            "address_2": "STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-886-5200",
            "fax_number": "909-382-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E VANDERBILT WAY",
            "address_2": "STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-886-5200",
            "fax_number": "909-382-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANAKRIYEH",
        "first_name": "MOHAMMAD",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A42526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "330698865",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A425260",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ51351Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.