Individual provider Active NPI

Devan Sanjay Pandya

  • Emergency Medicine Physician
  • Riverside, CA
National Provider Identifier
1659875797
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A163879 Issued in CA
Practice address
4445 Magnolia Ave
Riverside, CA 92501-4135
Phone
(951) 788-3000
NPI assigned
Mar 22, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A163879 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4445 Magnolia Ave
Riverside, CA 92501-4135

Mailing address

4445 Magnolia Ave
Riverside, CA 92501-4135
Phone (951) 788-3537

Other practice location 1

999 San Bernardino Rd
Upland, CA 91786-4920
Phone (909) 985-2811

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200916002914 CA Practitioner - Emergency Medicine 0941628325 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A163879CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Apr 1, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 1, 2021 Accepting new patients
Mountain View Emergency Physicians Medical Group, Inc. Emergency Medicine CurrentSince Aug 1, 2020 Accepting new patients

Locations

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

999 San Bernardino Rd
Upland, CA 91786
Phone (909) 920-4841

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1659875797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014135",
            "telephone_number": "951-788-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014135",
            "telephone_number": "951-788-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "999 San Bernardino Rd",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917864920",
            "country_code": "US",
            "telephone_number": "909-985-2811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANDYA",
        "first_name": "DEVAN",
        "middle_name": "SANJAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-22",
        "last_updated": "2021-12-08",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A163879",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.