Fred F Soeprono, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G28216 Issued in CA

Practice address

25084 Barton Rd Apt B
Loma Linda, CA 92354-2828

Phone

(909) 796-2211

Fax

(909) 796-6937

NPI assigned

Aug 18, 2006

Last updated

Jan 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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

DermatologyAlso: Internal Medicine

Education

Loma Linda University School of Medicine, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

77.33 of 100Reported as group

Quality

54.66

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JIAADA/Endpoint/JIAADA

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.

• Soeprono Medical Corporation

  • Dermatopathology Physician
  • Redlands, CA
  • NPI 1306194261
  Medicare reassignment NPD Authorized official
• Jennifer Hayhurst Physician Assistant Apc

  dba Radiant Dermatology

  • Dermatology Physician
  • Redlands, CA
  • NPI 1699456392
  Medicare reassignment NPD
• Steven E Hodgkin MD a Professional Corporation

  • Specialist
  • Victorville, CA
  • NPI 1699885053
  Medicare reassignment
• Todd C Rau MD Inc

  • Plastic and Reconstructive Surgery Physician
  • Redlands, CA
  • NPI 1609448802
  NPD
• K. D. Macknet, M.D., Inc.

  dba Loma Linda Dermatology Medical Group

  • Dermatology Physician
  • Loma Linda, CA
  • NPI 1083791644
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673136000000",
    "number": "1659485746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25084 BARTON RD",
            "address_2": "APT B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542828",
            "telephone_number": "909-796-2211",
            "fax_number": "909-796-6937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25084 BARTON RD APT B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542828",
            "telephone_number": "909-796-2211",
            "fax_number": "909-796-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOEPRONO",
        "first_name": "FRED",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-01-08",
        "certification_date": "2023-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G28216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G282160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan William Smits, MD
• Eugene Peter Snissarenko, M.D.
• Alix Snodgrass
• Douglas Soderblom, O.D.
• Robert Eugene Soderblom, MD
• Sindy Sohail, PA-C
• Andy Han-Byul Sohn, MD
• Roger D Sohn, DDS
• Daniil Alexandrovich Sokolov, MD
• Daniel H Soler

• Dermatology Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2023; 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.