NPIMap

Individual provider Active NPI

Taher M. Attia Khalil, M.D.

  • Nephrology Physician
  • Riverside, CA
National Provider Identifier
1962458752
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A62790 Issued in CA
Practice address
3660 Park Sierra Dr
Suite 208
Riverside, CA 92505-3059
Phone
(951) 687-2800
Fax
(951) 687-7290
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A62790 CA Primary

Addresses

Primary practice location

3660 Park Sierra Dr
Suite 208
Riverside, CA 92505-3059

Mailing address

3660 Park Sierra Dr Ste 203
Riverside, CA 92505-3071
Phone (951) 687-3400

Other identifiers 1

IdentifierTypeStateIssuer
00A627900MedicaidCA

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
I20080425000307 CA Practitioner - NephrologyPractitioner - Internal Medicine 1557383783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates Medical Group IncGroup PAC ID 5092604447, 64 clinicians

Practice addresses (Care Compare)

3660 Park Sierra Dr
Suite 208
Riverside, CA 92505-3071
Phone (951) 687-2800

Hospital & facility affiliations

  • DaVita Magnolia West Dialysis Dialysis facility, Riverside, CA, CCN 552553
  • DaVita Riverside Mission Home Training Dialysis facility, Riverside, CA, CCN 552627
  • Riverside Community Hospital Hospital, Riverside, CA, CCN 050022
  • Parkview Community Hospital Medical Center Hospital, Riverside, CA, CCN 050102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A62790CAMDNephrology Physician

Practice roles (7 of 8)

OrganizationSpecialtyStatusNew patients
Nephrology Associates Medical Group Inc Nephrology CurrentSince Oct 1, 2007 Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Uhs Corona Inc Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
San Gorgonio Memorial Hospital Past Accepting new patients
Nephrology Associates Medical Group, Inc. PastSince Aug 8, 2021 Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

3660 Park Sierra Dr
Ste 203
Riverside, CA 92505
Phone (951) 687-3400

3660 Park Sierra Dr
Ste 208
Riverside, CA 92505
Phone (951) 687-2800

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: taher.khalil.1@19859.direct.athenahealth.com

Organizations & group practices 7

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 3

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1962458752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 PARK SIERRA DR STE 203",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053071",
            "telephone_number": "951-687-3400",
            "fax_number": "951-687-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 PARK SIERRA DR",
            "address_2": "SUITE 208",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053059",
            "telephone_number": "951-687-2800",
            "fax_number": "951-687-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "TAHER",
        "middle_name": "M. ATTIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A62790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A627900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.