Active NPI
Dylan Ross Eberhardt
- Speech-Language Pathologist
- Chino Hills, CA
National Provider Identifier
1821653395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 28508
- Practice address
- 14837 Peyton Dr
Chino Hills, CA 91709-2075 - Phone
- (909) 606-3010
- NPI assigned
- May 9, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 28508 | CA | Primary |
Addresses
Primary practice location
14837 Peyton Dr
Chino Hills, CA 91709-2075
Mailing address
201 W Broadway Apt 411
Anaheim, CA 92805-0002
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14321821 | Other | ASHA NUMBER | |
| 28508 | Other | CA | STATE SLP LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Casamba | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28508 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557360000000",
"number": "1821653395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W BROADWAY APT 411",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928050002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14837 PEYTON DR",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917092075",
"telephone_number": "909-606-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBERHARDT",
"first_name": "DYLAN",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-09",
"last_updated": "2019-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "28508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA NUMBER",
"identifier": "14321821",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE SLP LICENSE",
"identifier": "28508",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Casamba",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "14837 Peyton Dr",
"city": "Chino Hills",
"state": "CA",
"country_code": "US",
"postal_code": "917092075",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chino Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.