Individual provider Active NPI

Tagbo Ekene Arene, MD, MPH

  • Psychiatry Physician
  • San Bernardino, CA
National Provider Identifier
1457474033
Registry record updated Jun 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A139396 Issued in CA
Practice address
303 E Vanderbilt Way County of San Bernardino DBH
San Bernardino, CA 92415-2804
Phone
(909) 388-0810
Fax
(909) 890-0281
NPI assigned
Apr 9, 2007
Last updated
Jun 22, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A139396 CA Primary

Addresses

Primary practice location

303 E Vanderbilt Way County of San Bernardino DBH
San Bernardino, CA 92415-2804

Mailing address

303 E. Vanderbilt Way
County of San Bernardino, DBH
San Bernardino, CA 92415
Phone (909) 388-0810

Other identifiers 1

IdentifierTypeStateIssuer
139396OtherCAMEDICAL BOARD OF CALIFORNIA (PHYSICIAN & SURGEON A LICENSE)

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
I20210617000499 CA Practitioner - Psychiatry 0749680411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Loma Linda University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of San BernardinoGroup PAC ID 3870499130, 76 clinicians

Practice addresses (Care Compare)

850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (909) 421-9475

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Bernardino Current Accepting new patients
County of San Bernardino CurrentSince Apr 1, 2021 Accepting new patients
County of San Bernardino CurrentSince Apr 1, 2021 Accepting new patients

Locations

850 E Foothill Blvd
Rialto, CA 92376
Phone (909) 421-9200

303 E Vanderbilt Way
Sn Bernrdno, CA 92415
Phone (909) 388-0801

Organizations & group practices 3

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": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498089600000",
    "number": "1457474033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E. VANDERBILT WAY",
            "address_2": "COUNTY OF SAN BERNARDINO, DBH",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92415",
            "telephone_number": "909-388-0810",
            "fax_number": "909-890-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E VANDERBILT WAY COUNTY OF SAN BERNARDINO DBH",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924152804",
            "telephone_number": "909-388-0810",
            "fax_number": "909-890-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARENE",
        "first_name": "TAGBO",
        "middle_name": "EKENE",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2017-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A139396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA (PHYSICIAN & SURGEON A LICENSE)",
            "identifier": "139396",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.