Edward R Serros MD Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

G30299 Issued in CA

Legal business name

EDWARD R SERROS MD INC

Practice address

7223 Church St
Suite a-20
Highland, CA 92346-5812

Phone

(909) 882-0702

Fax

(909) 886-6704

NPI assigned

Jul 21, 2006

Last updated

Oct 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly Diane Swanson

Title

Account Manager

Phone

(909) 882-0702

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven Merrill Beutler, MD

  • Infectious Disease Physician
  • San Bernardino, CA
  • NPI 1184630121
  NPD (past)
• Hai Thuong Phan, MD

  • Nephrology Physician
  • Highland, CA
  • NPI 1104817840
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1669492591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7223 CHURCH ST",
            "address_2": "SUITE A-20",
            "city": "HIGHLAND",
            "state": "CA",
            "postal_code": "923465812",
            "telephone_number": "909-882-0702",
            "fax_number": "909-886-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7223 CHURCH ST",
            "address_2": "SUITE A-20",
            "city": "HIGHLAND",
            "state": "CA",
            "postal_code": "923465812",
            "telephone_number": "909-882-0702",
            "fax_number": "909-886-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD R SERROS MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "909-882-0702",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G30299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G302990",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary P. Dubisz, MD
• Brandon Dudar, DDS
• Russell Dunagan, PHARMD
• East Highland Care, Inc (Canyon View Pacific Home)
• Sarah Wael Ebrahim, OD
• Eg Medtransp
• Oli J Eide
• Eight Healthcare
• Mohammed K Elsayed, MD
• Mohamed Sami Elsharif, M.D

• Nephrology Physician in Highland, CA
• Providers in Highland, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.