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LADAN MODALLEL MD
NPI 1669633376
Pediatrics in San Bernardino, CA

Active since June 24, 2008PECOS Enrolled
1574 W BASE LINE ST STE 107, SAN BERNARDINO, CA 92411(909) 386-1880(909) 386-1882 Get Directions Write a Review

NPPES record last updated: August 18, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 7, 2023, Feb 2, 2022, Apr 27, 2021 and 2 more (5 updates tracked since 2019).

About Ladan Modallel Md NPPES

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

LADAN MODALLEL MD (NPI 1669633376) is an individual pediatrics provider in San Bernardino, California, licensed in California (117285) and active in the NPI registry since June 2008. She is enrolled in Medicare PECOS and maintains a secondary practice location in Moses Lake.

NPPES Registry Identity

NPI1669633376
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameLADAN MODALLELCredential: MD
Location Address1574 W BASE LINE ST STE 107San Bernardino, CA 92411-1736
Mailing Address742 W Highland AveSan Bernardino, CA 92405-3839 · (909) 386-1880 · Fax (909) 386-1882
Phone(909) 386-1880
Fax(909) 386-1882
Sole ProprietorNo
Enumeration DateJune 24, 2008
Last NPPES UpdateAugust 18, 20255 updates tracked since enumeration
NPPES CertifiedAugust 18, 2025
✔ NPI 1669633376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in CA · 117285✔ Licensed in KY · 44915✔ Licensed in WA · MD60914735
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.
1574 W BASE LINE ST STE 107, San Bernardino, CA 92411
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Secondary Practice Location 1

Location 11550 S Pioneer Way Ste 200Moses Lake, WA 98837-4614 · Phone (509) 793-9787 · Fax (509) 764-3263

Other Identifiers 1

Medicaid2122359WA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ladan Modallel Md 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 Reassignments

2

Medicare enrollment records show Ladan Modallel reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Community Health Centers Of The Central Coast, Inc
146 mi
Federally Qualified Health Center (FQHC)
4711 HIGHWAY 166
New Cuyama, CA 93254
  • Reassigned Medicare billing, California enrollment
  • 213 clinicians in this Medicare group
NPI 1508105008 (661) 766-2149
Golden Valley Health Center
270 mi
Federally Qualified Health Center (FQHC)
13161 JEFFERSON ST
Le Grand, CA 95333
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Golden Valley Health Centers
  • 440 clinicians in this Medicare group
NPI 1356325310 (209) 389-1900

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 3

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

MIRIAM RIVERA
Community Health Worker
1574 W BASE LINE ST STE 107
SAN BERNARDINO, CA 92411
San Bernardino County (909) 386-1880
MISS AROUNRATSAMI SAKOUNPHONG PHYSICIAN ASSISTANT
Physician Assistant
1574 W BASE LINE ST STE 107
SAN BERNARDINO, CA 92411
San Bernardino County (909) 386-1880
SAN MARCOS MEDICAL GROUP INC.
Clinical Medical Laboratory
1574 W BASE LINE ST STE 107
SAN BERNARDINO, CA 92411
San Bernardino County (909) 386-1880

Frequently 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 Ladan Modallel's NPI number?

The NPI number for Ladan Modallel is 1669633376. It was assigned to this individual provider in the NPPES registry on June 24, 2008.

Where is Ladan Modallel located?

Ladan Modallel practices at 1574 W Base Line St Ste 107, San Bernardino, CA 92411. The listed phone number is (909) 386-1880.

What is Ladan Modallel's specialty?

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

Is Ladan Modallel enrolled in Medicare?

Yes. Ladan Modallel is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Ladan Modallel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ladan Modallel reassigns Medicare benefits to 2 organizations: Community Health Centers Of The Central Coast, Inc (New Cuyama, CA) and Golden Valley Health Center (Le Grand, CA). Each 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 Ladan Modallel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Ladan Modallel was last updated on August 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.