Individual provider Active NPI

Anthony Benigno, PSY.D.

  • Clinical Psychologist
  • Fontana, CA
National Provider Identifier
1356560668
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 26432 Issued in CA
Practice address
16465 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1242
Phone
(909) 244-9593
NPI assigned
Apr 25, 2007
Last updated
May 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY26432 CA
Clinical Psychologist 103TC0700X PSY 26432 CA Primary

Addresses

Primary practice location

16465 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1242

Mailing address

16465 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1242
Phone (909) 244-9593

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140912000782 CA Practitioner - Clinical Psychologist 4981821089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anthony Benigno PSYD Psychological Services PCGroup PAC ID 5193068765, 3 clinicians

Practice addresses (Care Compare)

16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242
Phone (909) 244-9593

7807 Laguna Blvd
Suite 400
Elk Grove, CA 95758-7953
Phone (909) 244-9593

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY26432CAMDPsychologist
PSY 26432CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Siyan Clinical Corporation Past Accepting new patients

Organizations & group practices 2

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1356560668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-244-9593",
            "fax_number": "833-903-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-244-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENIGNO",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY26432",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 26432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.