NPIMap

Individual provider Active NPI

John Andrew Fagan, MD

  • Family Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1306904628
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G060968 Issued in CA
Practice address
10787 Laurel St
Rancho Cucamonga, CA 91730-3828
Phone
(909) 982-7741
Fax
(909) 931-9568
NPI assigned
Dec 6, 2006
Last updated
Mar 25, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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 G060968 CA Primary

Addresses

Primary practice location

10787 Laurel St
Rancho Cucamonga, CA 91730-3828

Mailing address

10787 Laurel St
Rancho Cucamonga, CA 91730-3828
Phone (909) 982-7741

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040412000355 CA Practitioner - Family PracticePractitioner - Geriatric Medicine 7618961970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of California, San Diego School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John a Fagan MD Family Practice IncGroup PAC ID 4880764471, 2 clinicians
Congregational HomesGroup PAC ID 6901907245, 19 clinicians

Practice addresses (Care Compare)

10787 Laurel St
Rancho Cucamonga, CA 91730-3828
Phone (909) 982-7741

900 E Harrison Ave
Pomona, CA 91767-2075
Phone (909) 624-5061

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions29
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G060968CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Hearing Science of Rancho Cucamonga, a Professional Audiology Corporat PastSince Jun 1, 2012 Accepting new patients
San Antonio Regional Hospital Past Accepting new patients

Locations

255 E Bonita Ave
Pomona, CA 91767
Phone (866) 724-4127

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: casacolina@direct.casacolina.org
  • Direct secure messaging: clinic.casacolina@direct.casacolina.org

Organizations & group practices 5

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 9

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": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364169600000",
    "number": "1306904628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10787 LAUREL ST",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303828",
            "telephone_number": "909-982-7741",
            "fax_number": "909-931-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10787 LAUREL ST",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303828",
            "telephone_number": "909-982-7741",
            "fax_number": "909-931-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "JOHN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2013-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G060968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.