Individual provider Active NPI

Thang Van Pham

  • Clinical Social Worker
  • Colton, CA
National Provider Identifier
1841457033
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 24278 Issued in CA
Practice address
400 N Pepper Ave
Colton, CA 92324-1801
Phone
(909) 580-1800
NPI assigned
May 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS 24278 CA Primary

Addresses

Primary practice location

400 N Pepper Ave
Colton, CA 92324-1801

Mailing address

400 N Pepper Ave
Colton, CA 92324-1801
Phone (909) 580-1800

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221103002981 CA Practitioner - Clinical Social Worker 3476920471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

540 W Baseline Rd
Suite 3
Claremont, CA 91711-1612
Phone (909) 625-7175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS 24278CAMDClinical Social Worker
24278CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Inland Psychiatric Medical Group, Inc. Clinical CurrentSince Sep 28, 2022 Accepting new patients
Inland Psychiatric Medical Group, Inc. CurrentSince Sep 28, 2022 Accepting new patients
Inland Psychiatric Medical Group, Inc. Clinical Current Accepting new patients

Locations

12555 Central Ave
Ste C
Chino, CA 91710
Phone (909) 613-0100

540 W Baseline Rd
Ste 3
Claremont, CA 91711
Phone (909) 542-0633

12442 Limonite Ave
Unit 104
Eastvale, CA 91752
Phone (951) 344-4451

24432 Muirlands Blvd
Ste 131
Lake Forest, CA 92630
Phone (714) 520-3000

23110 Atlantic Cir
Ste F
Moreno Valley, CA 92553
Phone (951) 243-6455

8710 Monroe Ct
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4870

1809 W Redlands Blvd
Redlands, CA 92373
Phone (909) 307-1320

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1841457033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "THANG",
        "middle_name": "VAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 24278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.