Individual provider Active NPI

Robert D Parkinson, PA-C

  • Physician Assistant
  • San Bernardino, CA
National Provider Identifier
1245261494
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11386 Issued in CA
Practice address
401 E Highland Ave Ste 251
San Bernardino, CA 92404-3800
Phone
(909) 882-4605
Fax
(909) 475-2680
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11386 CA Primary

Addresses

Primary practice location

401 E Highland Ave Ste 251
San Bernardino, CA 92404-3800

Mailing address

3400 Data Dr
Attn: Credentialing/Payer Enrollment
Rancho Cordova, CA 95670-7956

Other identifiers 1

IdentifierTypeStateIssuer
PA11386OtherCALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA11386CAMDPhysician Assistant
11386CAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation Past Accepting new patients

Organizations & group practices 1

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505952000000",
    "number": "1245261494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "address_2": "ATTN: CREDENTIALING/PAYER ENROLLMENT",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE STE 251",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043800",
            "telephone_number": "909-882-4605",
            "fax_number": "909-475-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKINSON",
        "first_name": "ROBERT",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2017-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA11386",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.