Aena D Han, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

52866 Issued in TN

Practice address

1505 W 17TH St Ste 1
San Bernardino, CA 92411-1202

Phone

(909) 887-6494

Fax

(909) 887-6043

NPI assigned

Feb 6, 2007

Last updated

Mar 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Aena D Payne Former name

Electronic endpoints 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: aena.han.p1@direct.scmedcenter.nextgenshare.com

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.

• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1104075282
  Medicare reassignment NPD
• Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • El Monte, CA
  • NPI 1225357114
  Medicare reassignment NPD
• Southern Monterey County Memorial Hospital

  dba Mee Memorial Healthcare System

  • Critical Access Hospital
  • King City, CA
  • NPI 1114917564
  Medicare reassignment NPD
• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1639241888
  NPD
• Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • Van Nuys, CA
  • NPI 1255729661
  NPD
• Southern California Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1447865415
  NPD
• Strategic Solutions-Panola Medical Center LLC

  dba Panola Medical Center

  • Rural Acute Care Hospital
  • Batesville, MS
  • NPI 1053873307
  NPD (past)
• TCH Pediatric Associates, Inc

  dba Texas Children's Pediatric Associates

  • Pediatrics Physician
  • Houston, TX
  • NPI 1225038326
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1679612212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W REDLANDS BLVD FL 2",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733145",
            "telephone_number": "909-890-0407",
            "fax_number": "909-890-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W 17TH ST STE 1",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111202",
            "telephone_number": "909-887-6494",
            "fax_number": "909-887-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAN",
        "first_name": "AENA",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "17791",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "52866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01972509",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aena.han.p1@direct.eisnerhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGenShare, Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1530 S Olive St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900153023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AENA",
            "last_name": "PAYNE",
            "middle_name": "D",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mirely Hamilton
• Seth Hamilton
• Timothy Edward Hammill, OD
• Linda Hammons, FNP
• Gabriel Jordan Hamstra
• Amanda Han, OTR/L
• John C Han, DDS
• Nicole Han
• Kimonique Danielle Hancock
• Jordan Elexander Haney

• Pediatrics Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.