NPIMap

Individual provider Active NPI

Parag Mehtani, M.D.

  • Nephrology Physician
  • San Bernardino, CA
National Provider Identifier
1770773160
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A100778 Issued in CA
Practice address
401 E Highland Ave Ste 551
San Bernardino, CA 92404-3840
Phone
(909) 882-9150
Fax
(909) 883-8972
NPI assigned
Jul 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A100778 CA Primary

Addresses

Primary practice location

401 E Highland Ave Ste 551
San Bernardino, CA 92404-3840

Mailing address

3660 Park Sierra Dr Ste 203
Riverside, CA 92505-3071
Phone (951) 687-3400

Other practice location 1

264 N Highland Springs Ave Ste 3B
Banning, CA 92220-3085
Phone (951) 769-9776

Other identifiers 1

IdentifierTypeStateIssuer
00A1007780MedicaidCA

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
I20090113000010 CA Practitioner - NephrologyPractitioner - General PracticePractitioner - Internal Medicine 2062575301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates Medical Group IncGroup PAC ID 5092604447, 64 clinicians

Practice addresses (Care Compare)

401 E Highland Ave
Suite 551
San Bernardino, CA 92404-3840
Phone (909) 882-9150

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100778CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates Medical Group Inc Nephrology CurrentSince Aug 1, 2011 Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
THC - Orange County, LLC Past Accepting new patients
Nephrology Associates Medical Group, Inc. PastSince Aug 8, 2021 Accepting new patients
Redlands Community Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
San Gorgonio Memorial Hospital Past Accepting new patients

Locations

264 N Highland Springs Ave
Ste 3B
Banning, CA 92220
Phone (951) 769-9776

3660 Park Sierra Dr
Ste 203
Riverside, CA 92505
Phone (951) 687-3400

3660 Park Sierra Dr
Ste 208
Riverside, CA 92505
Phone (951) 687-2800

401 E Highland Ave
Ste 551
Sn Bernrdno, CA 92404
Phone (909) 882-1759

399 E Highland Ave
Ste 329
Sn Bernrdno, CA 92404
Phone (909) 886-1001

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: parag.mehtani.1@19859.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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": "1185840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1770773160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 PARK SIERRA DR STE 203",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053071",
            "telephone_number": "951-687-3400",
            "fax_number": "951-687-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE STE 551",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043840",
            "telephone_number": "909-882-9150",
            "fax_number": "909-883-8972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "264 N Highland Springs Ave Ste 3B",
            "address_purpose": "LOCATION",
            "city": "Banning",
            "state": "CA",
            "postal_code": "922203085",
            "country_code": "US",
            "telephone_number": "951-769-9776",
            "fax_number": "951-769-9026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEHTANI",
        "first_name": "PARAG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-31",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A100778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A1007780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.