Saint Elias Medical Group

Key facts

NPI

1457020760

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

Legal business name

SAINT ELIAS MEDICAL GROUP

Practice address

1183 E Foothill Blvd Ste 135
Upland, CA 91786-4082

Phone

(909) 498-6293

NPI assigned

Sep 9, 2021

Organization subpart

No

Authorized official

Name

Maher I Danhash, MD NPI 1689993313

Title

Owner

Phone

(909) 498-6293

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

Practitioners 2

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

• Maher Danhash, MD Family Medicine Physician · Upland, CA · NPI 1689993313
  Medicare reassignment NPD Authorized official CA · FAMILY MEDICINE
• Pamela Ann Mack Family Nurse Practitioner · Upland, CA · NPI 1881309045
  Medicare reassignment NPD CA

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• ELITE FAMILY MEDICAL CENTER Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 20, 2021.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1457020760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD STE 135",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864082",
            "telephone_number": "909-498-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD STE 135",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864082",
            "telephone_number": "909-498-6293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT ELIAS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "DANHASH",
        "authorized_official_first_name": "MAHER",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-498-6293",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELITE FAMILY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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