Active NPI
Samuel Dequina Bernal, MD, PHD
- Internal Medicine Physician
- Los Angeles, CA
National Provider Identifier
1942225016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G75613
- Practice address
- 200 Medical Plaza
#365
Los Angeles, CA 90095 - Phone
- (310) 825-0631
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G75613 | CA | Primary |
Addresses
Primary practice location
200 Medical Plaza
#365
Los Angeles, CA 90095
Mailing address
20000 Calvert St
Woodland Hills, CA 91367-3814
Phone (818) 347-4212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G756130 | Other | CA | MEDICAL PPIN # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G75613 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synergy Hematology Oncology Medical Associates, Inc. | Past | Accepting new patients | |
| Synergy Hematology Oncology Medical Associates Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba N/a
- Specialist
- West Hollywood, CA
- NPI 1164455960
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942225016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20000 CALVERT ST",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913673814",
"telephone_number": "818-347-4212",
"fax_number": "818-347-4040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MEDICAL PLAZA",
"address_2": "#365",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90095",
"telephone_number": "310-825-0631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNAL",
"first_name": "SAMUEL",
"middle_name": "DEQUINA",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G75613",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL PPIN #",
"identifier": "00G756130",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.