NPIMap

Individual provider Active NPI

Cong Thanh Phan, M.D.

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1386778033
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A780920 Issued in CA
Practice address
8235 Rochester Ave Ste 110
Rancho Cucamonga, CA 91730-0719
Phone
(909) 484-4900
Fax
(909) 781-2949
NPI assigned
Mar 15, 2007
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 00A780920 NU
Internal Medicine Physician 207R00000X A780920 CA Primary

Addresses

Primary practice location

8235 Rochester Ave Ste 110
Rancho Cucamonga, CA 91730-0719

Mailing address

8235 Rochester Ave Ste 110
Rancho Cucamonga, CA 91730-0719
Phone (909) 484-4900

Other practice location 1

4950 San Bernardino St Ste 107
Montclair, CA 91763-2328
Phone (909) 963-0800

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
I20040720000815 CA Practitioner - Internal Medicine 1759364466 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albany Medical College of Union University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

8235 Rochester Ave
Suite 110 120
Rancho Cucamonga, CA 91730-0718
Phone (909) 963-0800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
40.79 of 100Reported as individual
Quality
20
Improvement activities
0
Cost
78.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A780920CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cong T. Phan M.D., Inc. Internal Medicine CurrentSince Apr 1, 2004 Accepting new patients
THC - Orange County, LLC Past Accepting new patients
Abraham Chen, D.O., Inc Past Accepting new patients
Viet D. Ta, MD & Tiffany L. Quan, MD Medical Associates Inc. Past Accepting new patients
Rancho Cucamonga Community Hospital, LLC Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients

Locations

4950 San Bernardino St
Ste 107
Montclair, CA 91763
Phone (909) 625-2393

7777 Milliken Ave
Ste 14
Rancho Cucamonga, CA 91730
Phone (909) 466-6310

9333 Base Line Rd
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4777

8235 Rochester Ave
Ste 110
Rch Cucamonga, CA 91730
Phone (909) 484-4900

8235 Rochester Ave
Ste 110120
Rch Cucamonga, CA 91730
Phone (909) 484-4900

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Serenity Hospice CareClaremont, CA, CCN 051765 Hospice Contracted Managing Employee Feb 20, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Rosedove Inc

    dba Serenity Hospice Care

    • Community Based Hospice Care Agency
    • Claremont, CA
    • NPI 1972585180

    Contracted Managing Employee

    CMS ownership

Organizations & group practices 7

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1386778033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8235 ROCHESTER AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300719",
            "telephone_number": "909-484-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8235 ROCHESTER AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300719",
            "telephone_number": "909-484-4900",
            "fax_number": "909-781-2949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4950 San Bernardino St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Montclair",
            "state": "CA",
            "postal_code": "917632328",
            "country_code": "US",
            "telephone_number": "909-963-0800",
            "fax_number": "909-296-7999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "CONG",
        "middle_name": "THANH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": "00A780920",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A780920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.