Individual provider Active NPI

Maher S. Kozman, MD

  • Child & Adolescent Psychiatry Physician
  • Fontana, CA
National Provider Identifier
1700957602
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
A46450 Issued in CA
Practice address
9961 Sierra Ave
Fontana, CA 92335-6720
Phone
(909) 427-3910
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X A46450 CA Primary

Addresses

Primary practice location

9961 Sierra Ave
Fontana, CA 92335-6720

Mailing address

2295 S Vineyard Ave
Ontario, CA 91761-7925
Phone (909) 427-3910

Electronic endpoints 1

TypeEndpointUseAffiliation
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110118000851 CA Practitioner - Psychiatry 9335338672 Reassigns benefits to 3 organizations
I20230829001288 OR Practitioner - Psychiatry 9335338672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

1686 Barton Rd
Redlands, CA 92373-1488
Phone (909) 558-9551

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A46450CAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jul 9, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 13, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jul 9, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jul 9, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 10, 2010 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 10, 2010 Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

5330 San Bernardino St
Montclair, CA 91763
Phone (909) 399-3700

2295 S Vineyard Ave
Ontario, CA 91761
Phone (866) 454-3485

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

3175 NE Aloclek Dr
Hillsboro, OR 97124
Phone (503) 240-6148

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Interoperability endpoints

  • Direct secure messaging: mkozman54450@direct.llu.edu
  • Direct secure messaging: mkozman2574919@ghc.direct-ci.net

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1700957602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2295 S VINEYARD AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917617925",
            "telephone_number": "909-427-3910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9961 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356720",
            "telephone_number": "909-427-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZMAN",
        "first_name": "MAHER",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A46450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.