Individual provider Active NPI

Simona Bianconi, M.D.

  • Pediatrics Physician
  • Bethesda, MD
National Provider Identifier
1235459140
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
241805 Issued in NY
Practice address
10 Center Dr
Building 10 Room 9D42
Bethesda, MD 20892-0001
Phone
(301) 496-8217
NPI assigned
Jun 3, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 241805 NY Primary

Addresses

Primary practice location

10 Center Dr
Building 10 Room 9D42
Bethesda, MD 20892-0001

Mailing address

10 Center Dr
Building 10 Room 9D42
Bethesda, MD 20892-0001
Phone (301) 496-8217

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191226002140 CA Practitioner - Medical Genetics and Genomics 3375977416 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Medical Genetics and Genomics
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

4405 Vandever Ave
San Diego, CA 92120-3315
Phone (619) 516-6606

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
241805NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 2, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 2, 2019 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jan 27, 2020 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Pediatrics CurrentSince Jan 27, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 2, 2019 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

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

10243 Genetic Center Dr
San Diego, CA 92121
Phone (858) 499-2704

Organizations & group practices 6

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": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1235459140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CENTER DR",
            "address_2": "BUILDING 10 ROOM 9D42",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208920001",
            "telephone_number": "301-496-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CENTER DR",
            "address_2": "BUILDING 10 ROOM 9D42",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208920001",
            "telephone_number": "301-496-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIANCONI",
        "first_name": "SIMONA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "241805",
            "primary": true
        }
    ],
    "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": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.