Viktoriya A Derjabin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

401 E Highland Ave Ste 351
San Bernardino, CA 92404-3830

Phone

(909) 475-8611

NPI assigned

Apr 30, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western Acute Care Surgeons IncGroup PAC ID 0143659862, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Western Acute Care Surgeons Inc

  • Surgery Physician
  • San Bernardino, CA
  • NPI 1417581059
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1811744634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE STE 351",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043830",
            "telephone_number": "909-820-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE STE 351",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043830",
            "telephone_number": "909-475-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERJABIN",
        "first_name": "VIKTORIYA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shayla M Dennon
• Breannyca Dent
• Dentistry of Shahgaldian Corp
• Department of Behavioral Health, San Bernardino County
• Department of Behavioral Health, San Bernardino County Ca
• Desai Drugs Inc
• Aditya Mukesh Desai, MD
• Darshi Mitesh Desai
• Kavita P Desai
• Sumit Desai, PHARM.D.

• Physician Assistant in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.