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BASSAM THEODORY MD
NPI 1790545986
Student in an Organized Health Care Education/Training Program in Fontana, CA

Active since March 22, 2024PECOS Enrolled
17234 VALLEY BLVD, BUILDING A, FONTANA, CA 92335(626) 400-7101 Get Directions Write a Review

NPPES record last updated: March 22, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Bassam Theodory Md NPPES

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

BASSAM THEODORY MD (NPI 1790545986) is an individual student in an organized health care education/training program in Fontana, California and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790545986
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameBASSAM THEODORYCredential: MD
Location Address17234 VALLEY BLVD, BUILDING AFontana, CA 92335
Mailing Address17234 Valley Blvd, Building AFontana, CA 92335
Phone(626) 400-7101
Sole ProprietorNo
Enumeration DateMarch 22, 2024
NPPES CertifiedMarch 19, 2024
✔ NPI 1790545986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
17234 VALLEY BLVD, BUILDING A, Fontana, CA 92335
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bassam Theodory 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.

Other Providers at the Same Location NPPES 15

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

SKYLAR RAINS MD
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-5084
ANNA TRAN DO
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-4128
SHIRLEY HUANG DO
Psychiatry & Neurology (Psychiatry)
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-4128
JOSEPH KIM MD
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-2608
ANTHONY AGHAJANI MD
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-5679
KAISER FONTANA MEDICAL CENTER
Family Medicine
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (833) 574-2273
RACHAELL DIAZ DO
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (805) 256-8938
ISAAC DAVID STEPHENS MD
Student in an Organized Health Care Education/Training Program
17234 VALLEY BLVD, BUILDING A
FONTANA, CA 92335
San Bernardino County (909) 427-2608

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 Bassam Theodory's NPI number?

The NPI number for Bassam Theodory is 1790545986. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Where is Bassam Theodory located?

Bassam Theodory practices at 17234 Valley Blvd, Building A, Fontana, CA 92335. The listed phone number is (626) 400-7101.

What is Bassam Theodory's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Bassam Theodory enrolled in Medicare?

Yes. Bassam Theodory is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Bassam Theodory was last updated on March 22, 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.