Autar Kristen Wali, M.D.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

A32290 Issued in CA

Practice address

155 W Willow St
Pomona, CA 91768-1829

Phone

(909) 865-2626

Fax

(909) 865-2010

NPI assigned

Nov 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

General SurgeryAlso: Colorectal Surgery (Proctology)

Education

Other, 1965

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pomona Valley Hospital Medical Center Hospital, Pomona, CA, CCN 050231

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Willow Partners Medical Corp

  • Colon & Rectal Surgery Physician
  • Pomona, CA
  • NPI 1942338827
  Medicare reassignment NPD Authorized official
• Anaheim Memorial Medical Center

  • General Acute Care Hospital
  • Anaheim, CA
  • NPI 1295782381
  NPD (past)
• Plastic Surgery So Cal Medical Group, Inc.

  • Plastic and Reconstructive Surgery Physician
  • Claremont, CA
  • NPI 1609178961
  NPD (past)
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• Prime Healthcare Services - Montclair, LLC

  • General Acute Care Hospital
  • Montclair, CA
  • NPI 1992721161
  NPD (past)
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)
• San Dimas Community Hospital, Inc.

  • Skilled Nursing Facility
  • San Dimas, CA
  • NPI 1568487619
  NPD (past)
• Yong Luke Lee Medical Corporation

  • Rehabilitation Hospital
  • Pomona, CA
  • NPI 1114245883
  NPD (past)

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

• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1407813660
  Care Compare affiliation

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1164601449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 W WILLOW ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917681829",
            "telephone_number": "909-865-2626",
            "fax_number": "909-865-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 W WILLOW ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917681829",
            "telephone_number": "909-865-2626",
            "fax_number": "909-865-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALI",
        "first_name": "AUTAR",
        "middle_name": "KRISTEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-02",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A32290",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "A32290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A322900",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0081880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ernet Waithaka, RN
• Christine Washington Walden, COUNSELOR
• Trenton D Walgenbach
• Walgreen Co
• Walgreen Co
• Devdas Wali, M.D.
• Diana Gail Walker, CATC
• Kimberly Renee Walker, O.D.
• Lena M Walker, STUDENT
• Angela Marie Wall

• Colon & Rectal Surgery Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Colon & Rectal Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.