Organization Active NPI

Thaker Urological Center, Inc.

  • Specialist
  • Ontario, CA
National Provider Identifier
1396108940
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A74757 Issued in CA
Legal business name
THAKER UROLOGICAL CENTER, INC.
Practice address
1791 E Holt Blvd Unit 101
Ontario, CA 91761-2118
Phone
(909) 460-0354
Fax
(909) 460-0367
NPI assigned
Mar 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Dr. Nimish Thaker, M.D.NPI 1871541961
Title
President
Phone
(909) 460-0354

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A74757 CA Primary

Addresses

Primary practice location

1791 E Holt Blvd Unit 101
Ontario, CA 91761-2118

Mailing address

1791 E Holt Blvd Unit 101
Ontario, CA 91761-2118
Phone (909) 460-0354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160922002552 CA Part B Supplier - Clinic/Group Practice 2961799622 Receives reassigned benefits from 1 practitioner
Practice locations: Ontario, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2126644Thaker Urological Center, Inc.1791 E Holt Blvd Unit 101, Ontario, CA 91761Certificate of waiverMar 1, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1396108940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 E HOLT BLVD UNIT 101",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917612118",
            "telephone_number": "909-460-0354",
            "fax_number": "909-460-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 E HOLT BLVD UNIT 101",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917612118",
            "telephone_number": "909-460-0354",
            "fax_number": "909-460-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAKER UROLOGICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-31",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "THAKER",
        "authorized_official_first_name": "NIMISH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-460-0354",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A74757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.