Individual provider Active NPI

Timothy Lawrence Standon, PA-C

  • Physician Assistant
  • Fontana, CA
National Provider Identifier
1700286077
Registry record updated Aug 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
51862 Issued in CA
Practice address
16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242
Phone
(909) 434-1150
NPI assigned
Aug 24, 2014
Last updated
Aug 24, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 51862 CA Primary

Addresses

Primary practice location

16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242

Mailing address

16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242
Phone (909) 434-1150

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141210001322 CA Practitioner - Physician Assistant 5698097285 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
51862CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Apr 16, 2025 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Apr 16, 2025 Accepting new patients
Premier Emergency Physicians of California Medical Group PC Physician Assistant Past Accepting new patients
Rainbow Basin Emergency Physicians, a Medical Corporation Physician Assistant Past Accepting new patients

Locations

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

28078 Baxter Rd
Murrieta, CA 92563
Phone (760) 533-4541

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1408838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408838400000",
    "number": "1700286077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-434-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-434-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANDON",
        "first_name": "TIMOTHY",
        "middle_name": "LAWRENCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-24",
        "last_updated": "2014-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.