NPIMap

Individual provider Active NPI

Kanokrat Suksompoth, M.D.

  • Infectious Disease Physician
  • Pomona, CA
National Provider Identifier
1831109131
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
A96983 Issued in CA
Practice address
255 E Bonita Ave BLDG 1B
Pomona, CA 91767-1923
Phone
(909) 275-7470
Fax
(909) 971-4532
NPI assigned
Aug 9, 2006
Last updated
Sep 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35749 AZ
Infectious Disease Physician 207RI0200X A96983 CA Primary

Addresses

Primary practice location

255 E Bonita Ave BLDG 1B
Pomona, CA 91767-1923

Mailing address

310 N Indian Hill Blvd
PMB 801
Claremont, CA 91711-4611
Phone (909) 275-7470

Other identifiers 4

IdentifierTypeStateIssuer
7789806OtherAZAETNA
117346MedicaidAZ
117346OtherAZHEALTH CHOICE OF AZ
2Z7810OtherAZHEALTH NET OF AZ

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
I20141028001582 CA Practitioner - Internal MedicinePractitioner - Infectious Disease 7911905773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inland Valley Infectious Disease Medical Group IncGroup PAC ID 2365455391, 5 clinicians

Practice addresses (Care Compare)

255 E Bonita Ave
BLDG 1B
Pomona, CA 91767-1923
Phone (909) 275-7470

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
85.5

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35749AZMDInternal Medicine Physician
A96983CAMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Premier Hospitalist Group Inc Internal Medicine PastSince Dec 23, 2013 Accepting new patients
Bullhead City Clinic Corp Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Chino Medical Group, Inc Internal Medicine Past Accepting new patients
Bullhead City Clinic Corp PastSince Apr 1, 2009 Accepting new patients

Locations

255 E Bonita Ave
Bldg 1
Pomona, CA 91767
Phone (909) 524-1940

255 E Bonita Ave
Bldg 1B
Pomona, CA 91767
Phone (909) 275-7470

255 E Bonita Ave
Bldg 9
Pomona, CA 91767
Phone (909) 450-0369

255 E Bonita Ave
Ste 1B
Pomona, CA 91767

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: casacolina@direct.casacolina.org
  • Direct secure messaging: clinic.casacolina@direct.casacolina.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1831109131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N INDIAN HILL BLVD",
            "address_2": "PMB 801",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114611",
            "telephone_number": "909-275-7470",
            "fax_number": "909-971-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE BLDG 1B",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-275-7470",
            "fax_number": "909-971-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKSOMPOTH",
        "first_name": "KANOKRAT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "35749",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "A96983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7789806",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117346",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CHOICE OF AZ",
            "identifier": "117346",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET OF AZ",
            "identifier": "2Z7810",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.