Ronald Demetri Liskanich, D.O.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

20A4952 Issued in CA

Practice address

954 W Foothill Blvd Ste B
Upland, CA 91786

Phone

(909) 949-7500

Fax

(909) 946-1133

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

DermatologyAlso: Anesthesiology

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J Robert West MD IncGroup PAC ID 8729990973, 141 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Merit-based Incentive Payment System (MIPS)

Final score

85.17 of 100Reported as group

Quality

74.51

Promoting interoperability

92

Improvement activities

40

Cost

82.72

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: ronald.liskanich@westderm.emadirect.md

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.

• J Robert West, M.D., Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1932154788
  Medicare reassignment Care Compare group NPD
• Chino Medical Group, Inc

  • Health Maintenance Organization
  • Chino, CA
  • NPI 1790730786
  NPD (past)
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)
• J. Robert West, M.D., Inc

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1114567997
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  Care Compare affiliation

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1245391820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 W FOOTHILL BLVD STE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863782",
            "telephone_number": "909-949-7500",
            "fax_number": "909-946-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 W FOOTHILL BLVD STE B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-949-7500",
            "fax_number": "909-946-1133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "954 W Foothill Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "91786",
            "country_code": "US",
            "telephone_number": "909-949-7500",
            "fax_number": "909-946-1133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LISKANICH",
        "first_name": "RONALD",
        "middle_name": "DEMETRI",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "20A4952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX49520",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "020A49520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Linero
• Angie Ling
• Lionel B Katchem, D.O., a Prof. Corp.
• Allen Eugene Lipscomb, LCSW
• Norma Angelica Lira, RDA
• Joanne Marie Lister, FNP C
• Ellen Liu, NP-C
• Tasha Liu, LVN
• Live Well Home Health Services, Inc.
• Living Angels Hospice Care

• Procedural Dermatology Physician in Upland, CA
• Providers in Upland, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.