Hanumantharao Damerla, M.D.,

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

A69165 Issued in CA

Practice address

1900 Sycamore Canyon Rd
San Dimas, CA 91773-1220

Phone

(626) 975-2968

Fax

(213) 639-1361

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Hanumantharao S.P. Damerla Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• County of San Bernardino

  dba Department of Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
  • NPI 1164467023
  Medicare reassignment

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364428800000",
    "number": "1225119464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900201912",
            "telephone_number": "213-738-2902",
            "fax_number": "213-639-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SYCAMORE CANYON RD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731220",
            "telephone_number": "626-975-2968",
            "fax_number": "213-639-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMERLA",
        "first_name": "HANUMANTHARAO",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A69165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANUMANTHARAO",
            "last_name": "DAMERLA",
            "middle_name": "S.P.",
            "prefix": "DR.",
            "credential": "M.D.,",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Naema Dahdoul, OTR/L
• Nghi Trung Dang, D.O.
• David & Margaret Home, Inc.
• Heidi Anne Davila, RDHAP
• Angela Davis, PHD
• Sarah Michelle Davis

• Child & Adolescent Psychiatry Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.