Theresa Win

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A138793 Issued in CA

Practice address

1805 Medical Center Dr
San Bernardino, CA 92411

Phone

(909) 887-6333

NPI assigned

Mar 25, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Thae Mar Former name

Electronic endpoints 1

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

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Department of State Hospitals

  • Psychiatric Hospital
  • Coalinga, CA
  • NPI 1124078704
  Medicare reassignment Care Compare group NPD
• Inpatient Specialists of California, PC

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1952792475
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Department of State Hospitals

  • Psychiatric Hospital
  • Patton, CA
  • NPI 1043249204
  NPD
• Department of State Hospitals

  • Psychiatric Hospital
  • Atascadero, CA
  • NPI 1174573802
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Lancaster, CA
  • NPI 1982863783
  NPD

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1538401856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12369 HIGH HORSE DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 MEDICAL CENTER DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-6333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9961 Sierra Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923356720",
            "country_code": "US",
            "telephone_number": "909-427-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIN",
        "first_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-25",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A138793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "THAE",
            "last_name": "MAR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristy Wilson
• Monzaa Wilson
• Quiana N Wilson, RN
• Sabrina Wilson
• Timothy Joseph Wilson
• Zin Thandar Win, MD
• Jack Norman Winchester, PHARMBS
• Kennita Wingfield-Coleman, MFT
• Deannah Maria Winslow, APCC6301
• Alexis Monique Winters-Dixon

• Internal Medicine Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; 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.
• 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.