Individual provider Active NPI

Kevin Lopez, MD

  • Student in an Organized Health Care Education/Training Program
  • Manhasset, NY
National Provider Identifier
1316526726
Registry record updated Apr 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
300 Community Dr
Manhasset, NY 11030-3816
Phone
(516) 562-0100
NPI assigned
Apr 4, 2021
Last updated
Apr 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

300 Community Dr
Manhasset, NY 11030-3816

Mailing address

300 Community Dr
Manhasset, NY 11030-3816

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
I20260203003872 CA Practitioner - Physical Medicine and Rehabilitation 1153809777 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Drexel University College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2025 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

Organizations & group practices 3

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": "1617494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617494400000",
    "number": "1316526726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303816",
            "telephone_number": "516-562-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-04",
        "last_updated": "2021-04-04",
        "certification_date": "2021-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.