Individual provider Active NPI

Carlos Adrian Sandoval, M.D.

  • Anesthesiology Physician
  • Loma Linda, CA
National Provider Identifier
1386055135
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A140851 Issued in CA
Practice address
11234 Anderson St
Gme Office Westerly Suite C
Loma Linda, CA 92354-2804
Phone
(909) 558-4015
NPI assigned
May 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X A140851 CA
Anesthesiology Physician 207L00000X A140851 CA Primary

Addresses

Primary practice location

11234 Anderson St
Gme Office Westerly Suite C
Loma Linda, CA 92354-2804

Mailing address

11234 Anderson St RM 2532
Loma Linda, CA 92354-2804
Phone (909) 558-4475

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20190910002556 CA Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 2668701038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Critical Care (Intensivists)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone (800) 954-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A140851CAMDCritical Care Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 25, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 25, 2020 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Sep 1, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

11234 Anderson St
Ofc
Loma Linda, CA 92350
Phone (909) 558-4074

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11234 Anderson St
#A600
Loma Linda, CA 92350
Phone (909) 558-2824

11234 Anderson St
Rm 2532
Loma Linda, CA 92350
Phone (909) 558-4475

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

Interoperability endpoints

  • Direct secure messaging: csandoval72552@direct.llu.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1386055135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST RM 2532",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "GME OFFICE WESTERLY SUITE C",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "CARLOS",
        "middle_name": "ADRIAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "CA",
            "license": "A140851",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A140851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.