Individual provider Active NPI

Leah Beranek

  • Speech-Language Assistant
  • Canyon Lake, CA
National Provider Identifier
1275047649
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
SPA2658 Issued in CA
Practice address
23660 Continental Dr
Canyon Lake, CA 92587-7753
Phone
(951) 265-8107
NPI assigned
Nov 21, 2017
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 2355S0801X SPA2658 CA Primary

Addresses

Primary practice location

23660 Continental Dr
Canyon Lake, CA 92587-7753

Mailing address

2621 Plaza del Amo
Unit 530
Torrance, CA 90503-9303

Other names 1

  • Leah Janke Other name

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200409002954 CA Practitioner - Qualified Speech Language Pathologist 5991134199 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SPA2658CAMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New Life Physical Therapy Services, PC Single Specialty CurrentSince Mar 1, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 21, 2022 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 21, 2022 Accepting new patients
Southern California Permanente Medical Group Single Specialty Current Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

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

245 W Sierra Madre Blvd
Sierra Madre, CA 91024
Phone (626) 325-3780

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1275047649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 PLAZA DEL AMO",
            "address_2": "UNIT 530",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905039303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23660 CONTINENTAL DR",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925877753",
            "telephone_number": "951-265-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERANEK",
        "first_name": "LEAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-21",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "SPA2658",
            "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": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LEAH",
            "last_name": "JANKE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Canyon Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.