Individual provider Active NPI

Khanh Q Pham, D.O.

  • Anesthesiology Physician
  • Redlands, CA
National Provider Identifier
1841221637
Registry record updated Mar 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
20A8578 Issued in CA
Practice address
2 W Fern Ave
Redlands, CA 92373-5916
Phone
(909) 793-3311
Fax
(909) 796-4158
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 20A8578 CA Primary

Addresses

Primary practice location

2 W Fern Ave
Redlands, CA 92373-5916

Mailing address

PO Box 10069
San Bernardino, CA 92423-0069
Phone (909) 793-3311

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20061003000204 CA Practitioner - Anesthesiology 3274538871 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Darin Rentz DO PCGroup PAC ID 7315333853, 131 clinicians

Practice addresses (Care Compare)

350 Terracina Blvd
Redlands, CA 92373-4850
Phone (909) 335-5593

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A8578CAMDAnesthesiology Physician
8578CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Beaver Medical Group P C Anesthesiology CurrentSince Jun 18, 2015 Accepting new patients
Darin Rentz DO PC Anesthesiology CurrentSince May 1, 2022 Accepting new patients
Beaver Medical Group P C CurrentSince Jun 18, 2015 Accepting new patients

Locations

600 N Highland Springs Ave
Banning, CA 92220
Phone (833) 443-6287

1901 W Lugonia Ave
Ste 100
Redlands, CA 92374
Phone (909) 557-1700

350 Terracina Blvd
Redlands, CA 92373
Phone (909) 335-5500

2 W Fern Ave
Redlands, CA 92373
Phone (909) 335-4137

Organizations & group practices 3

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 1

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425513600000",
    "number": "1841221637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10069",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924230069",
            "telephone_number": "909-793-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W FERN AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735916",
            "telephone_number": "909-793-3311",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KHANH",
        "middle_name": "Q",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2015-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "20A8578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.