Active NPI
Gerald Terrell Ponder Jr., D
- Rehabilitation Practitioner
- Upland, CA
National Provider Identifier
1306143573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- D9514099
- Practice address
- 151 Armstrong Way
Apt B
Upland, CA 91786-6335 - Phone
- (909) 354-6110
- NPI assigned
- Feb 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | D9514099 | CA | Primary |
Addresses
Primary practice location
151 Armstrong Way
Apt B
Upland, CA 91786-6335
Mailing address
151 Armstrong Way
Apt B
Upland, CA 91786-6335
Phone (909) 354-6110
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9514099 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298419200000",
"number": "1306143573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 ARMSTRONG WAY",
"address_2": "APT B",
"city": "UPLAND",
"state": "CA",
"postal_code": "917866335",
"telephone_number": "909-354-6110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 ARMSTRONG WAY",
"address_2": "APT B",
"city": "UPLAND",
"state": "CA",
"postal_code": "917866335",
"telephone_number": "909-354-6110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONDER",
"first_name": "GERALD",
"middle_name": "TERRELL",
"name_suffix": "Jr.",
"credential": "D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-23",
"last_updated": "2011-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "D9514099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.