NPIMap

Individual provider Active NPI

Lesanemariam Tenkir Banko, M.D.

  • Cardiovascular Disease Physician
  • Victorville, CA
National Provider Identifier
1861648560
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A104321 Issued in CA
Practice address
12984 Hesperia Rd
Ste 100
Victorville, CA 92395-5819
Phone
(760) 843-7675
Fax
(760) 843-7649
NPI assigned
Aug 13, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A104321 CA Primary

Addresses

Primary practice location

12984 Hesperia Rd
Ste 100
Victorville, CA 92395-5819

Mailing address

12984 Hesperia Rd
Ste 100
Victorville, CA 92395-5819
Phone (760) 843-7675

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
I20081110000246 CA Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 5991767485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12984 Hesperia Rd
Suite 100
Victorville, CA 92395-5819
Phone (760) 843-7675

Hospital & facility affiliations

  • Victor Valley Global Medical Center Hospital, Victorville, CA, CCN 050517
  • Providence St Mary Medical Center Hospital, Apple Valley, CA, CCN 050300
  • Desert Valley Hospital Hospital, Victorville, CA, CCN 050709

Merit-based Incentive Payment System (MIPS)

Final score
21.88 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
72.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A104321CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lesan Banko, M.D. Inc. Cardiovascular Disease CurrentSince Mar 1, 2010 Accepting new patients
The New York and Presbyterian Hospital Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients
Park Slope Medical Service PC Cardiovascular Disease Past Accepting new patients
Choice Healthcare Associates Inc Past Accepting new patients
Uhs of Oklahoma, LLC Past Accepting new patients
Victor Valley Community Hospital Past Accepting new patients
St. Mary Medical Center Past Accepting new patients

Locations

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

12984 Hesperia Rd
Ste 100
Victorville, CA 92395
Phone (760) 843-7675

16850 Bear Valley Rd
Ste 105
Victorville, CA 92395

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 8

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 5

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": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1861648560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12984 HESPERIA RD",
            "address_2": "STE 100",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955819",
            "telephone_number": "760-843-7675",
            "fax_number": "760-843-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12984 HESPERIA RD",
            "address_2": "STE 100",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955819",
            "telephone_number": "760-843-7675",
            "fax_number": "760-843-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKO",
        "first_name": "LESANEMARIAM",
        "middle_name": "TENKIR",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-13",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A104321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.