Individual provider Active NPI

Suraiya Simi Rahman, MD

  • Pediatrics Physician
  • Pasadena, CA
National Provider Identifier
1871559898
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C54271 Issued in CA
Practice address
243 Wallis St Unit 4
Pasadena, CA 91106-5419
Phone
(626) 278-8727
NPI assigned
Apr 26, 2006
Last updated
May 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C54271 CA Primary

Addresses

Primary practice location

243 Wallis St Unit 4
Pasadena, CA 91106-5419

Mailing address

243 Wallis St Unit 4
Pasadena, CA 91106-5419
Phone (626) 278-8727

Other practice location 1

1011 Baldwin Park Blvd # 4
Baldwin Park, CA 91706-5806
Phone (626) 278-8727

Other identifiers 1

IdentifierTypeStateIssuer
209308105MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20220923001465 CA Practitioner - Pediatric Medicine 7517918139 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shamynds TMS Brain-StimGroup PAC ID 2668982232, 6 clinicians

Practice addresses (Care Compare)

2012 19TH St
Suite 200
Sacramento, CA 95818-1668
Phone (916) 538-6498

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C54271CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Apr 14, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 14, 2024 Accepting new patients
Suraiya Rahman Medical Corporation CurrentSince Feb 18, 2024 Accepting new patients

Locations

1011 Baldwin Park Blvd
Baldwin Park, CA 91706
Phone (626) 851-1011

1011 Baldwin Park Blvd
#4
Baldwin Park, CA 91706
Phone (626) 278-8727

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1871559898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 WALLIS ST UNIT 4",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911065419",
            "telephone_number": "626-278-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 WALLIS ST UNIT 4",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911065419",
            "telephone_number": "626-278-8727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Baldwin Park Blvd # 4",
            "address_purpose": "LOCATION",
            "city": "Baldwin Park",
            "state": "CA",
            "postal_code": "917065806",
            "country_code": "US",
            "telephone_number": "626-278-8727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "SURAIYA",
        "middle_name": "SIMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-05-07",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C54271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209308105",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1011 Baldwin Park Blvd",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917065806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.