Kenneth Wayne Hart, M.D.

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

G019894 Issued in CA

Practice address

1454 E 2ND St
San Bernardino, CA 92408-0118

Phone

(909) 382-7146

Fax

(909) 382-7101

NPI assigned

Dec 29, 2005

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 3

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

Interoperability endpoints

• Direct secure messaging: khart54211@direct.llu.edu

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.

• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Redlands, CA
  • NPI 1235189911
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Orthopaedic Surgery Physician
  • Loma Linda, CA
  • NPI 1275582918
  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1689651671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7146",
            "fax_number": "909-382-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7146",
            "fax_number": "909-382-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "CA",
            "license": "G019894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INLAND EMPIRE HEALTH PLAN",
            "identifier": "J891171",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INLAND EMPIRE HEALTH PLAN",
            "identifier": "F141171",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "00G198940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tristyn Harrison
• Walter Hugh Harrison
• Jalise Erin Hart
• Jintill Hart
• Judy A Hart, CFNP
• Linda Hart
• Hart'S Hospice & Associates Inc
• Harvest Point Behavioral Center, LLC
• Harvey House, Inc.
• Joanne Ardell Harwick, MFT

• Public Health & General Preventive Medicine Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Public Health & General Preventive Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; 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.