Brian Thomas Haven, DPM

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

E6017 Issued in CA

Practice address

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172

Phone

(909) 863-1097

NPI assigned

Aug 20, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Podiatry

Education

Temple University School of Podiatric Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverside-San Bernardino County Indian Health Inc 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Riverside-San Bernardino County Indian Health, Inc.

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

  TX

  Medicare reassignment Care Compare group NPD
• Riverside-San Bernardino County Indian Health, Inc

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

  • Federally Qualified Health Center (FQHC)
  • Thermal, CA
  • NPI 1043363641
  Care Compare group NPD
• Riverside-San Bernardino County Indian Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Temecula, CA
  • NPI 1316090798
  Care Compare group
• Riverside-San Bernardino County Indian Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Banning, CA
  • NPI 1437202124
  Care Compare group
• Riverside-San Bernardino County Indian Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Anza, CA
  • NPI 1679204325
  Care Compare group
• Riverside-San Bernardino County Indian Health, Inc.

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

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1609356591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-863-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-863-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVEN",
        "first_name": "BRIAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-20",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "POD-001008",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E6017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Terrace Modern Dentistry, Inc
• Mykell Gray
• Natalie Ann Hagan, AGACNP
• Donald L Hamby, D.O.
• Rheanna Denise Harrod
• Health Enterprises
• Health Redesigned
• Clarissa Justine Hernandez
• Gabrielle Hernandez
• Gilbert NMN Hernandez Jr., D.C.

• All providers in Grand Terrace, CA
• Primary Podiatric Medicine Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.