KANDAVIN SUMILAT
NPI 1609457753
Nurse Practitioner - Family in San Bernardino, CA

Q: What is Kandavin Sumilat's NPI number?

The NPI number for Kandavin Sumilat is 1609457753. It was assigned to this individual provider in the NPPES registry on April 20, 2021.

Q: What is Kandavin Sumilat's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kandavin Sumilat was last updated on June 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.

Active since April 20, 2021PECOS Enrolled

2195 CLUB CENTER DR STE A, SAN BERNARDINO, CA 92408(909) 654-2119 Get Directions Write a Review

NPPES record last updated: June 9, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 27, 2023, Apr 20, 2021 (2 updates tracked since 2021).

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About Kandavin Sumilat NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KANDAVIN SUMILAT (NPI 1609457753) is an individual family provider in San Bernardino, California, licensed in California (95022634) and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1609457753

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKANDAVIN SUMILAT

Location Address2195 CLUB CENTER DR STE ASan Bernardino, CA 92408-4162

Mailing AddressPo Box 10069San Bernardino, CA 92423-0069 · (909) 335-4188

Phone(909) 654-2119

Sole ProprietorNo

Enumeration DateApril 20, 2021

Last NPPES UpdateJune 9, 20262 updates tracked since enumeration

NPPES CertifiedJune 9, 2026

✔ NPI 1609457753 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95022634

2195 CLUB CENTER DR STE A, San Bernardino, CA 92408

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kandavin Sumilat is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kandavin Sumilat reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Beaver Medical Group P C

5.5 mi

Family Medicine

2 WEST FERN AVENUE
Redlands, CA 92373

Reassigned Medicare billing, California enrollment
635 clinicians in this Medicare group

NPI 1649503319 (909) 793-3311

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

43 services39 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

18 services18 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92408 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$104.64 typical visit price

range $19.37 – $146.42

Typical copayment $26.16 (range $4.84 – $36.60)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HUA WANG M.D

Medical Genetics (Clinical Genetics (M.D.))