NPIMap

Individual provider Active NPI

Lance Mitchell Siegel, MD

  • Ophthalmology Physician
  • Upland, CA
National Provider Identifier
1629044185
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G72351 Issued in CA
Practice address
1246 E Arrow Hwy
Ste a
Upland, CA 91786-4955
Phone
(909) 931-9675
Fax
(909) 931-3239
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X G72351 CA Primary

Addresses

Primary practice location

1246 E Arrow Hwy
Ste a
Upland, CA 91786-4955

Mailing address

1246 E Arrow Hwy Ste a
Upland, CA 91786-4955
Phone (909) 931-9675

Other identifiers 1

IdentifierTypeStateIssuer
00G723510MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040217000399 CA Practitioner - Ophthalmology 6002700838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Virginia Commonwealth University, School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1246 E Arrow Hwy a
Upland, CA 91786-4955

1246E Arrow Hwy a
Upland, CA 91786-4955

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
72351CAMDPharmacist

Practice roles (16 of 17)

OrganizationSpecialtyStatusNew patients
Children'S Eye Institute, Inc. Ophthalmology CurrentSince Nov 1, 2003 Accepting new patients
Children'S Hospital Los Angeles Medical Group, Inc. CurrentSince Jan 6, 2019 Accepting new patients
Pomona Valley Hospital Medical Center Ophthalmology Past Accepting new patients
Community Hospital of San Bernardino Ophthalmology Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Pih Health Whittier Hospital Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Corwin Medical Group Inc Ipa Past Accepting new patients
Chino Medical Group, Inc Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients
St. Mary Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients

Locations

12442 Limonite Ave
Unit 203
Eastvale, CA 91752
Phone (951) 821-5188

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

1246 E Arrow Hwy
Ste A
Upland, CA 91786
Phone (909) 931-9675

1246 E Arrow Hwy
Upland, CA 91786

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1629044185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 E ARROW HWY STE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864955",
            "telephone_number": "909-931-9675",
            "fax_number": "909-931-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 E ARROW HWY",
            "address_2": "STE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864955",
            "telephone_number": "909-931-9675",
            "fax_number": "909-931-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEGEL",
        "first_name": "LANCE",
        "middle_name": "MITCHELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G72351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G723510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.