Matthew Allen
Individual provider Active NPI Psychiatry Physician · Fontana, CA
NPI 1679216121 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1679216121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 190732 (CA)
- Practice address
- 17234 Valley Blvd.
BLDG. a
Fontana, CA 92335 - Phone
- (402) 450-9429
- NPI assigned
- Apr 13, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- California University of Science and Medicine, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
393 E Walnut St 3Rd FL
Pasadena, CA 91188-0001
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260313003642 | CA | Practitioner - Psychiatry | 7517407539 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 190732 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 190732 | CA | Yes |
Addresses
Primary practice location
17234 Valley Blvd.
BLDG. a
Fontana, CA 92335
Mailing address
17234 Valley Blvd.
BLDG. a
Fontana, CA 92335
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 |
Other providers in Fontana, CA
- Uzma Rifat Ali
- Michael Mohamed Aljabban
- Lupe A Alle-Corliss
- Randall M Alle-Corliss
- Kimberly Irene Allen
- Allied Medical Supply, Inc
- Jane M Allison
- Rebeca S Allison
- Alondra Loya
- Leopoldo John Alonzo
All providers in Fontana, CA · Psychiatry Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.