MRS. TARA RITHAPORN AGENA M.D.
NPI 1629249859
Pediatrics in San Bernardino, CA

Q: What is Tara Agena's NPI number?

The NPI number for Tara Agena is 1629249859. It was assigned to this individual provider in the NPPES registry on March 15, 2008.

Q: What is Tara Agena's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Tara Agena was last updated on November 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since March 15, 2008PECOS Enrolled

565 N MOUNT VERNON AVE, SAN BERNARDINO, CA 92411(909) 884-9091(909) 383-7013 Get Directions Write a Review

NPPES record last updated: November 29, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Mrs. Tara Rithaporn Agena M.d. NPPES

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

MRS. TARA RITHAPORN AGENA M.D. (NPI 1629249859) is an individual pediatrics provider in San Bernardino, California, licensed in California (A97352) and active in the NPI registry since March 2008. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629249859

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameMRS. TARA RITHAPORN AGENACredential: M.D.

Location Address565 N MOUNT VERNON AVESan Bernardino, CA 92411-2661

Mailing Address685 Carnegie Dr, Suite 230San Bernardino, CA 92408-3502 · (909) 890-0407 · Fax (909) 890-4597

Phone(909) 884-9091

Fax(909) 383-7013

Sole ProprietorNo

Enumeration DateMarch 15, 2008

Last NPPES UpdateNovember 29, 2021

✔ NPI 1629249859 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in CA · A97352

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

565 N MOUNT VERNON AVE, San Bernardino, CA 92411

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Other Identifiers 1

Medicaid00A973520CA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Tara Rithaporn Agena M.d. 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 Tara Agena reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group

7.3 mi

Health Maintenance Organization

9961 SIERRA AVE
Fontana, CA 92335

Reassigned Medicare billing, California enrollment
5,228 clinicians in this Medicare group

NPI 1689606196 (909) 427-3910

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92411 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.

NOOSHIN SALEHI MD

Internal Medicine