Individual provider Active NPI

Phill Victor Halamandaris, M.D.

  • Psychiatry Physician
  • Indio, CA
National Provider Identifier
1194944736
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
G66098 Issued in CA
Practice address
47825 Oasis St
Indio Mental Health Clinic
Indio, CA 92201-6950
Phone
(760) 863-8455
Fax
(760) 863-8587
NPI assigned
Apr 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X G66098 CA Primary

Addresses

Primary practice location

47825 Oasis St
Indio Mental Health Clinic
Indio, CA 92201-6950

Mailing address

47825 Oasis St
Indio Mental Health Clinic
Indio, CA 92201-6950
Phone (760) 863-8455

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
I20081118000866 CA Practitioner - Psychiatry 8426118670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Southern California Keck School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of RiversideGroup PAC ID 6507754488, 190 clinicians

Practice addresses (Care Compare)

47825 Oasis St
Indio, CA 92201-6950
Phone (760) 863-8517

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66098CAMDClinical Social Worker
G66098CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Riverside CurrentSince Aug 20, 2012 Accepting new patients
County of Riverside CurrentSince Aug 20, 2012 Accepting new patients
County of Riverside Current Accepting new patients

Locations

1330 W Ramsey St
Ste 100
Banning, CA 92220
Phone (951) 849-7142

47825 Oasis St
Indio, CA 92201
Phone (760) 863-8455

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": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1194944736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47825 OASIS ST",
            "address_2": "INDIO MENTAL HEALTH CLINIC",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922016950",
            "telephone_number": "760-863-8455",
            "fax_number": "760-863-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47825 OASIS ST",
            "address_2": "INDIO MENTAL HEALTH CLINIC",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922016950",
            "telephone_number": "760-863-8455",
            "fax_number": "760-863-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALAMANDARIS",
        "first_name": "PHILL",
        "middle_name": "VICTOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G66098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indio, CA

Sources for this page

Verify at the official NPI Registry.