Foothill Pediatric & Adolescent Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

FOOTHILL PEDIATRIC & ADOLESCENT CLINIC

Practice address

1330 W Covina Blvd
Suite 106
San Dimas, CA 91773

Phone

(909) 599-6876

Fax

(909) 592-9787

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. George M Madanat, MD

Title

President

Phone

(909) 599-6876

Specialties & licenses 1

Addresses

Other names 1

• George M Madanat M Inc Former legal business name

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12077/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Irma Yolanda Gonzalez, MD

  • Pediatrics Physician
  • Pasadena, CA
  • NPI 1417919929
  NPD (past)
• Michael G Madanat, M.D.

  • Pediatrics Physician
  • San Dimas, CA
  • NPI 1841499563
  NPD (past)
• Praful H Shah, MD

  • Pediatrics Physician
  • San Dimas, CA
  • NPI 1306912936
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1952499378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD",
            "address_2": "SUITE 106",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "91773",
            "telephone_number": "909-599-6876",
            "fax_number": "909-592-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD",
            "address_2": "SUITE 106",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "91773",
            "telephone_number": "909-599-6876",
            "fax_number": "909-592-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILL PEDIATRIC & ADOLESCENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "MADANAT",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-599-6876",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George M Madanat M Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Florence Hospice Care Incorporation
• Martha Alejandra Flores Tabares
• Nevin Flores
• Kean Flowers, LCSW
• Kimberly J Foon, D.D.S.
• Foothills Neurological Medical GP
• Cadence Michelle Foutz
• Genevieve Maya Fragoso
• Kali Jean France, OTR/L
• Evan Franco

• Pediatrics Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.