CONG T. PHAN M.D., INC.
NPI 1114354396
Internal Medicine in Rancho Cucamonga, CA
About Cong T. Phan M.d., Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CONG T. PHAN M.D., INC. (NPI 1114354396) is a healthcare organization registered as an internal medicine in Rancho Cucamonga, California and active in the NPI registry since October 2013. The organization holds a CLIA Waiver certificate valid through January 3, 2028, maintains a secondary practice location in Montclair, and lists Cong T. Phan, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Cong T. Phan M.d., Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Cong T. Phan M.D., Inc., which bills Medicare for the services this clinician delivers.
Clinician (1)
Rancho Cucamonga, CA 91730
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2296754
Cong T Phan · Rancho Cucamonga, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Cong T. Phan M.D., Inc.'s NPI number?
The NPI number for Cong T. Phan M.D., Inc. is 1114354396. It was assigned to this organization in the NPPES registry on October 2, 2013.
Where is Cong T. Phan M.D., Inc. located?
Cong T. Phan M.D., Inc. is located at 8235 Rochester Ave Ste 110, Rancho Cucamonga, CA 91730. The listed phone number is (909) 484-4900.
What is Cong T. Phan M.D., Inc.'s specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Cong T. Phan M.D., Inc. enrolled in Medicare?
Yes. Cong T. Phan M.D., Inc. is registered in the Medicare PECOS enrollment system.
When is Cong T. Phan M.D., Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Cong T. Phan M.D., Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Cong T. Phan M.D., Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Cong T. Phan M.D., Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2296754) is associated with this NPI, valid through January 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Cong T. Phan M.D., Inc. was last updated on September 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Cong T. Phan M.d., Inc. · NPI 1114354396
Internal Medicine organization in Rancho Cucamonga, California. Organization record, active in the CMS NPPES registry since October 2, 2013.
## Identity
- **NPI:** 1114354396 (Entity type: Organization)
- **Enumerated:** October 2, 2013
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Cong Phan, PRESIDENT
## Practice location
- **Address:** 8235 ROCHESTER AVE STE 110, Rancho Cucamonga, CA 91730-0719
- **Phone:** (909) 484-4900 · **Fax:** (909) 781-2949
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 25, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1114354396) · Data from the CMS NPPES public registry.