Active NPI
Kaylene R Carr, M.D.
- Obstetrics & Gynecology Physician
- San Bernardino, CA
National Provider Identifier
1497046361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- A124094
- Practice address
- 1800 N. Western Ave Ste 204
San Bernardino, CA 92411-1353 - Phone
- (909) 474-9952
- Fax
- (909) 474-9951
- NPI assigned
- Apr 27, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A124094 | CA | |
| Obstetrics & Gynecology Physician | 207V00000X | A124094 | CA | Primary |
Addresses
Primary practice location
1800 N. Western Ave Ste 204
San Bernardino, CA 92411-1353
Mailing address
6767 Brockton Ave
Riverside, CA 92506-3023
Phone (951) 823-0441
Other practice location 1
6767 Brockton Ave
Riverside, CA 92506-3023
Phone (951) 823-0441
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A124094 | CA | MD | Obstetrics & Gynecology Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
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.
-
- Obstetrics & Gynecology Physician
- Riverside, CA
- NPI 1912248782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1497046361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6767 BROCKTON AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925063023",
"telephone_number": "951-823-0441",
"fax_number": "951-823-0447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 N. WESTERN AVE STE 204",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924111353",
"telephone_number": "909-474-9952",
"fax_number": "909-474-9951"
}
],
"practiceLocations": [
{
"address_1": "6767 Brockton Ave",
"address_purpose": "LOCATION",
"city": "Riverside",
"state": "CA",
"postal_code": "925063023",
"country_code": "US",
"telephone_number": "951-823-0441",
"fax_number": "951-823-0447",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARR",
"first_name": "KAYLENE",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-27",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A124094",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "CA",
"license": "A124094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.