NPIMap

Individual provider Active NPI

David Song

  • Urology Physician
  • Chino, CA
National Provider Identifier
1699115972
Registry record updated Apr 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
2013018892 Issued in MO
Practice address
5365 Walnut Ave Ste a
Chino, CA 91710-2622
Phone
(909) 902-0009
Fax
(909) 206-0628
NPI assigned
Jul 1, 2013
Last updated
Apr 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 2013018892 MO Primary

Addresses

Primary practice location

5365 Walnut Ave Ste a
Chino, CA 91710-2622

Mailing address

5365 Walnut Avenue Ste a
Chino, CA 91710-2622
Phone (626) 234-9178

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200312001243 CA Practitioner - Urology 1951739614 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Saint Louis University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
David G Song MD IncGroup PAC ID 9133557895, 2 clinicians

Practice addresses (Care Compare)

12611 9TH St
Suite C
Chino, CA 91710-3528
Phone (626) 234-9178

1350 W Covina Blvd
San Dimas, CA 91773-3245
Phone (909) 599-6811

14642 Newport Ave
Suite 101
Tustin, CA 92780-6058
Phone (657) 255-8860

18575 Gale Ave
Suite 108
City of Industry, CA 91748-1382
Phone (626) 788-9080

639 E Foothill Blvd
Suite C
San Dimas, CA 91773-1253
Phone (909) 480-3488

9041 Magnolia Ave
Suite 7
Riverside, CA 92503-3941
Phone (951) 577-0085

9080 Colima Rd
Whittier, CA 90605-1600
Phone (562) 954-3561

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013018892MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chino Stone & Surgery Center CurrentSince Aug 6, 2023 Accepting new patients
Prime Access Medical Group Urology CurrentSince Jul 1, 2024 Accepting new patients
Primecare Medical Group Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients

Locations

12611 9th St
Ste 108
Chino, CA 91710

12611 9th St
Ste B
Chino, CA 91710
Phone (714) 589-4507

12611 9th St
Ste D
Chino, CA 91710
Phone (909) 902-0009

12611 9th St
Ste F
Chino, CA 91710
Phone (626) 616-8863

1417 W Beverly Blvd
Ste 106
Montebello, CA 90640
Phone (310) 242-0919

201 W Garvey Ave
Ste 102502
Monterey Park, CA 91754
Phone (909) 574-4686

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: david.song@237015600267268.direct.elationemr.com

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1699115972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5365 WALNUT AVENUE STE A",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917102622",
            "telephone_number": "626-234-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5365 WALNUT AVE STE A",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917102622",
            "telephone_number": "909-902-0009",
            "fax_number": "909-206-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-01",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "2013018892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.