Reginald G M Abraham, M D
Individual provider Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Fountain Valley, CA
NPI 1720042864 · NPPES record last updated Jun 5, 2012
Key facts
- NPI
- 1720042864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- License
- A75917 (CA)
- Practice address
- 11100 Warner Ave
Suite 258
Fountain Valley, CA 92708-7506 - Phone
- (714) 549-5990
- Fax
- (714) 549-0866
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Cardiac Surgery
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adventist Health Physicians Network
Practice addresses (Care Compare)
1007 Live Oak Blvd
Suite B2
Yuba City, CA 95991-3454
Phone (530) 671-8718
11100 Warner Ave
Suite 258
Fountain Valley, CA 92708-7512
Phone (714) 549-5990
Hospital & facility affiliations
- Adventist Health and Rideout
- Uci Health-Orange
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary artery bypass graft (CABG) | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050124000171 | CA | Practitioner - Cardiac Surgery |
3577512003 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A75917 | CA | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
Practice roles (5 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventist Health Physicians Network | Current | Accepting new patients | |
| Adventist Health Physicians Network | Current |
Accepting new patients | |
| Adventist Health Physicians Network | Current |
Accepting new patients | |
| Sach Physician Billing Trust | Current |
Accepting new patients | |
| Memorial Medical Group Inc | Past | Accepting new patients |
Locations
401 I St
Marysville, CA 95901
Phone (530) 671-3526
8816 Foothill Blvd
Ste 322
Rch Cucamonga, CA 91730
999 San Bernardino Rd
Upland, CA 91786
Phone (909) 920-4841
1007 Live Oak Blvd
Ste B2
Yuba City, CA 95991
Phone (530) 671-8718
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A75917 | CA | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | A75917 | CA | Yes |
Addresses
Primary practice location
11100 Warner Ave
Suite 258
Fountain Valley, CA 92708-7506
Mailing address
11100 Warner Ave
Suite 258
Fountain Valley, CA 92708-7506
Phone (714) 549-5990
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A75917 | Medicaid | CA |
Other providers in Fountain Valley, CA
- Gabriel Abarca Villegas
- Abc Health Center Inc
- Gail Frances Liezl Abcede
- Mariam Abdelshahed
- Abhishek Bhardwaj, MD Corporation
- Acacia HH&P of Southern California, LLC
- Acacia Hospice of Southern California, LLC
- Acceptance Detox LLC
- Keith Ryan Aceron
- Acessmd Medical Group, Inc
All providers in Fountain Valley, CA · Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.