Individual provider Active NPI

Rosanna Wadie Iskander, M.D.

  • Family Medicine Physician
  • San Dimas, CA
National Provider Identifier
1265500896
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A40133 Issued in CA
Practice address
1330 W Covina Blvd Ste 102
San Dimas, CA 91773-3200
Phone
(909) 592-3323
Fax
(877) 992-6240
NPI assigned
Dec 1, 2006
Last updated
Jul 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A40133 CA Primary

Addresses

Primary practice location

1330 W Covina Blvd Ste 102
San Dimas, CA 91773-3200

Mailing address

1330 W Covina Blvd Ste 102
San Dimas, CA 91773-3200
Phone (909) 592-3323

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
I20040902001515 CA Practitioner - Family Practice 2466428214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rosanna Iskander MD Inc.Group PAC ID 6305029950, 2 clinicians

Practice addresses (Care Compare)

1330 W Covina Blvd
San Dimas, CA 91773-3200
Phone (909) 592-3323

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A40133CAMDFamily Medicine Physician
40133CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rosanna W Iskander M D Inc Family Medicine CurrentSince Nov 1, 2010 Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Armen Nercessian DO Inc Past Accepting new patients
Azusa Way Family Medical Clinic Family Medicine Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Gold Medical Group, Inc. Family Medicine PastSince Nov 1, 2007 Accepting new patients

Locations

5920 Atlantic Blvd
Maywood, CA 90270
Phone (323) 562-2535

1330 W Covina Blvd
Ste 102
San Dimas, CA 91773
Phone (909) 592-3323

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1265500896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD STE 102",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733200",
            "telephone_number": "909-592-3323",
            "fax_number": "877-992-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD STE 102",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733200",
            "telephone_number": "909-592-3323",
            "fax_number": "877-992-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISKANDER",
        "first_name": "ROSANNA",
        "middle_name": "WADIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A40133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

Verify at the official NPI Registry.