Richard Phan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT33976-TLG Issued in CA

Practice address

200 Minor LN
Berkeley, CA 94720

Phone

(510) 642-2020

NPI assigned

Jul 12, 2018

Last updated

Jul 12, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverside-San Bernardino County Indian Health IncGroup PAC ID 4789867805, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: richard.phan.p1@direct.atlantiseyecare.nextgenshare.com
• Direct secure messaging: rphan@californiaeye.intellechartdirect.net

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.

• Riverside-San Bernardino County Indian Health, Inc.

  dba San Manuel Indian Health

  • Federally Qualified Health Center (FQHC)
  • Grand Terrace, CA
  • NPI 1174676670

  TX

  Medicare reassignment Care Compare group NPD
• Azul Vision Inc.

  dba Azul Vision

  • Ophthalmology Physician
  • Pasadena, CA
  • NPI 1285247528

  Optometrist

  NPD
• California Eye Specialists Medical Group, Inc

  • Specialist
  • Pasadena, CA
  • NPI 1699713099
  NPD
• First Desert Obstetrics & Gynecology Medical Associates, Inc.

  • Obstetrics & Gynecology Physician
  • Indio, CA
  • NPI 1184792590
  NPD
• Riverside-San Bernardino County Indian Health, Inc

  dba Santa Rosa Indian Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Mountain Center, CA
  • NPI 1366028086
  NPD
• Riverside-San Bernardino County Indian Health, Inc.

  dba Soboba Indian Health

  • Federally Qualified Health Center (FQHC)
  • San Jacinto, CA
  • NPI 1639222144

  Gastroenterology

  NPD
• Ahmc San Gabriel Valley Medical

  dba AHMC San Gabriel Valley Medical Center

  • Skilled Nursing Facility
  • San Gabriel, CA
  • NPI 1710174818
  NPD (past)
• Community Hospital of San Bernardino

  dba Community Convalescent Center of San Bernardino

  • Pediatric Skilled Nursing Facility
  • San Bernardino, CA
  • NPI 1851395685
  NPD (past)
• Riverside Healthcare System, L.P.

  dba Riverside Community Hospital

  • Rehabilitation Hospital Unit
  • Riverside, CA
  • NPI 1053358010
  NPD (past)

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1609352798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N HANOVER ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015007",
            "telephone_number": "714-515-9721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MINOR LN",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94720",
            "telephone_number": "510-642-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT33976-TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Pettit, AMFT
• Grant Pezeshki
• Eden Anne Pfeiffer
• Catherine Pfister, L.C.S.W.
• Steve Pham, M.D.
• Pharmaca Integrative Pharmacy, Inc.
• Stacey Phelps, PA-C
• Connie Philipp, PH.D., LCSW
• Yvette Phillips Aldama
• Justin Paul Phillips

• Optometrist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.