Organization Active NPI

Western Vascular a Medical Corporation

  • Vascular Surgery Physician
  • San Bernardino, CA
National Provider Identifier
1497486245
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
WESTERN VASCULAR A MEDICAL CORPORATION
Practice address
401 E Highland Ave Ste 351
San Bernardino, CA 92404-3830
Phone
(909) 475-8611
NPI assigned
Jun 22, 2022
Organization subpart
Yes
Parent organization
WESTERN BARIATRIC, A MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Douglas Krahn, MDNPI 1922029677
Title
Owner/Provider
Phone
(909) 475-8611

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

401 E Highland Ave Ste 351
San Bernardino, CA 92404-3830

Mailing address

PO Box 9086
Redlands, CA 92375-2286
Phone (833) 989-1009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250908001962 CA Part B Supplier - Clinic/Group Practice 4981106093 Receives reassigned benefits from 3 practitioners
Practice locations: Redlands, CA; San Bernardino, CA

National Provider Directory

National Provider Directory
Part of
Western Bariatric a Medical Corporation

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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": "1655856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1497486245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9086",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923752286",
            "telephone_number": "833-989-1009",
            "fax_number": "801-931-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE STE 351",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043830",
            "telephone_number": "909-475-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN VASCULAR A MEDICAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN BARIATRIC, A MEDICAL CORPORATION",
        "enumeration_date": "2022-06-22",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "KRAHN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "909-475-8611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "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 Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.