Individual provider Active NPI

Andy Nguyen Le, MSW

  • Clinical Social Worker
  • Rancho Cucamonga, CA
National Provider Identifier
1184286593
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW115829 Issued in CA
Practice address
9500 Haven Ave
Rancho Cucamonga, CA 91730-5807
Phone
(909) 980-6700
NPI assigned
Jul 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW115829 CA Primary
Mental Health Counselor 101YM0800X ASW90266 CA

Addresses

Primary practice location

9500 Haven Ave
Rancho Cucamonga, CA 91730-5807

Mailing address

27261 Las Ramblas Ste 220
Mission Viejo, CA 92691-6468

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828002490 CA Practitioner - Clinical Social Worker 4981143468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1188 N Euclid St
Anaheim, CA 92801-1900
Phone (714) 254-2747

5475 E la Palma Ave
Anaheim, CA 92807-2075
Phone (714) 279-6088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW90266CAMDMental Health Counselor
LCSW115829CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jul 9, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 9, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

Organizations & group practices 3

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": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1184286593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27261 LAS RAMBLAS STE 220",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 HAVEN AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305807",
            "telephone_number": "909-980-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "ANDY",
        "middle_name": "NGUYEN",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-05",
        "last_updated": "2024-10-15",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW115829",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW90266",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.