Yevgeny Klebanov, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A126559 Issued in CA

Practice address

120 La Casa Via Ste 101
Walnut Creek, CA 94598-3092

Phone

(925) 296-0344

Fax

(925) 947-5424

NPI assigned

Jul 4, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 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 Medicine

Education

Drexel University College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St. Joseph Hospital Hospital, Orange, CA, CCN 050069

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: yklebanov1631877@oc.providencedirect.org

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD
• Regents of the University of California

  • Pain Medicine (Anesthesiology) Physician
  • San Diego, CA
  • NPI 1376646869
  Medicare reassignment NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Regents of the University of California

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1508968751
  NPD
• Regents of the University of California

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1558463927
  NPD
• John Muir Health

  • Rehabilitation Hospital Unit
  • Walnut Creek, CA
  • NPI 1447269303
  NPD (past)
• John Muir Health

  • General Acute Care Hospital
  • Concord, CA
  • NPI 1801821376
  NPD (past)

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

• St Joseph Hospital of Orange

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1912982216
  Care Compare affiliation
• St. Joseph Hospital of Orange

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1558575746
  Care Compare affiliation

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

{
    "created_epoch": "1341360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1841555976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BROADWAY UNIT 1401",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 LA CASA VIA STE 101",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983092",
            "telephone_number": "925-296-0344",
            "fax_number": "925-947-5424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 E Chapman Ave",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928693204",
            "country_code": "US",
            "telephone_number": "714-633-1011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLEBANOV",
        "first_name": "YEVGENY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-04",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A126559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "yklebanov1631877@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1100 W Stewart Dr",
            "city": "Orange",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928683849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Atkinson Kives, M.D.
• Kla Audiology Services, Inc.
• Andrie Klass, MS, CGC
• Ian Christopher Klause, RADT
• Mark Klebanov, M.D.
• Karen Lee Kleckner, M.A., L.M.F.T.
• Debra Ann Klein, RNC, MSN, NP
• Kimberly Ann Klein, M.D.
• Louis Arthur Klein, M.D.
• Michael Steven Klemm, MD

• Internal Medicine Physician in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.