Dominique Lucienne Mall, MD.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A86680 Issued in CA

Practice address

11211 Sepulveda Blvd
Mission Hills, CA 91345-1115

Phone

(818) 365-9531

NPI assigned

May 23, 2006

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

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Nephrology

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

High Desert Nephrology Medical Associates IncGroup PAC ID 2860439288, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Mary Medical Center Hospital, Apple Valley, CA, CCN 050300

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: dmall25176@direct.acumenmd.com

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.

• High Desert Nephrology Medical Associates, Inc.

  • Nephrology Physician
  • Victorville, CA
  • NPI 1407865652
  Medicare reassignment Care Compare group NPD
• Providence Facey Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
  • NPI 1194083824
  NPD (past)
• Banner Sun City Medical Group

  • Multi-Specialty Clinic/Center
  • Sun City, AZ
  • NPI 1902067200
  NPD (past)
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Mary Medical Center

  • Advanced Practice Midwife
  • Apple Valley, CA
  • NPI 1043406440

  Hospital

  Care Compare affiliation
• St. Mary Medical Center

  • General Acute Care Hospital
  • Apple Valley, CA
  • NPI 1669456299
  Care Compare affiliation
• St. Mary Medical Center

  • General Acute Care Hospital
  • Apple Valley, CA
  • NPI 1710109186
  Care Compare affiliation

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342483200000",
    "number": "1821043423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5637",
            "fax_number": "818-837-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11211 SEPULVEDA BLVD",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451115",
            "telephone_number": "818-365-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALL",
        "first_name": "DOMINIQUE",
        "middle_name": "LUCIENNE",
        "credential": "MD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A86680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A8668000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mylene Macasaet, P.T.
• Arjomand Avi Madadshahi, DDS
• Yasuhiro Maeda, M.D.
• Derek Duy Mai, M.D.
• Rabia A Malik, M.D.
• Steven I Manasevit, PA-C
• Sarah Manheim, LCSW
• Divya Manivannan, M.D..
• Kasra Manouchehrian
• Mary Manuel, N.P.

• Nephrology Physician in Mission Hills, CA
• Providers in Mission Hills, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.