Active NPI
Roger Dwain Hall, DO
- Family Medicine Physician
- Pomona, CA
National Provider Identifier
1336118579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A5507
- Practice address
- 790 East Bonita Ave
2ND Floor
Pomona, CA 91767-1906 - Phone
- (909) 447-8585
- Fax
- (909) 447-8593
- NPI assigned
- Mar 17, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A5507 | CA | Primary |
Addresses
Primary practice location
790 East Bonita Ave
2ND Floor
Pomona, CA 91767-1906
Mailing address
840 Towne Center Dr
Chaparral Medical Group
Pomona, CA 91767-5900
Phone (909) 398-1550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX55070 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A5507 | CA | MD | Family Medicine Physician |
| 5507 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1336118579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 TOWNE CENTER DR",
"address_2": "CHAPARRAL MEDICAL GROUP",
"city": "POMONA",
"state": "CA",
"postal_code": "917675900",
"telephone_number": "909-398-1550",
"fax_number": "909-398-1573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 EAST BONITA AVE",
"address_2": "2ND FLOOR",
"city": "POMONA",
"state": "CA",
"postal_code": "917671906",
"telephone_number": "909-447-8585",
"fax_number": "909-447-8593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "ROGER",
"middle_name": "DWAIN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A5507",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX55070",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.