NPIMap

Individual provider Active NPI

Akhenaton Pappoe, M.D

  • Internal Medicine Physician
  • Pomona, CA
National Provider Identifier
1972703114
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A95638 Issued in CA
Practice address
1900 Royalty Dr
Suite 130
Pomona, CA 91767-3032
Phone
(909) 623-1561
Fax
(909) 629-1418
NPI assigned
Jul 24, 2007
Last updated
Jul 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A95638 CA Primary

Addresses

Primary practice location

1900 Royalty Dr
Suite 130
Pomona, CA 91767-3032

Mailing address

1900 Royalty Dr
Suite 130
Pomona, CA 91767-3032
Phone (909) 623-1561

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
I20071027000083 CA Practitioner - Internal MedicinePractitioner - Nephrology 1052408762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

999 San Bernardino Rd
Upland, CA 91786-4920
Phone (909) 623-1561

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A95638CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Yong Luke Lee Medical Corporation Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients

Locations

1900 Royalty Dr
Ste 130
Pomona, CA 91767
Phone (909) 623-1561

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: akhenaton.pappoe.1@2708.direct.athenahealth.com
  • Direct secure messaging: casacolina@direct.casacolina.org

Organizations & group practices 6

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.

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": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1972703114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR",
            "address_2": "SUITE 130",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673032",
            "telephone_number": "909-623-1561",
            "fax_number": "909-629-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR",
            "address_2": "SUITE 130",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673032",
            "telephone_number": "909-623-1561",
            "fax_number": "909-629-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAPPOE",
        "first_name": "AKHENATON",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A95638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.