Premalata Manickam, MD - Medicare Pediatrics in Fontana, CA

Premalata Manickam, MD is a medicare enrolled "Pediatrics" physician in Fontana, California. Her current practice location is 9985 Sierra Ave, Kaiser Permanente, Mob 2b, Fontana, California. You can reach out to her office (for appointments etc.) via phone at (909) 427-5993.

Premalata Manickam is licensed to practice in California (license number C52156) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1154353654.

Contact Information

Premalata Manickam, MD
9985 Sierra Ave, Kaiser Permanente, Mob 2b,
Fontana, CA 92335-6720
(909) 427-5993
(909) 427-4287



Physician's Profile

Full NamePremalata Manickam
GenderFemale
SpecialityPediatrics
Location9985 Sierra Ave, Fontana, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1154353654
  • Provider Enumeration Date: 07/07/2006
  • Last Update Date: 10/13/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 0143415752
  • Enrollment ID: I20101109000850

Medical Identifiers

Medical identifiers for Premalata Manickam such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1154353654NPI-NPPES
3386785MedicaidMI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208000000XPediatrics C52156 (California)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Premalata Manickam allows following entities to bill medicare on her behalf.
Entity NameSouthern California Permanente Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1770515280
PECOS PAC ID: 6002729175
Enrollment ID: O20031110000678

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Entity NameSouthern California Permanente Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1316979834
PECOS PAC ID: 6002729175
Enrollment ID: O20040126000823

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› Verified 4 days ago

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Premalata Manickam is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Premalata Manickam, MD
9985 Sierra Ave, Kaiser Permanente ,pediatric Clinic Mob 2b,
Fontana, CA 92335-6720

Ph: (909) 427-5993
Premalata Manickam, MD
9985 Sierra Ave, Kaiser Permanente, Mob 2b,
Fontana, CA 92335-6720

Ph: (909) 427-5993

News Archive

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Even as more and more American quit smoking cigarettes, individuals with serious psychological distress (SPD) are much less likely to extinguish their habit.

Resverlogix' Phase 2 ASSERT trial dosing complete ahead of schedule

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Snowe's departure from the Senate highlights ever-shrinking political center

Her surprise retirement also underscores what some say is a rift within the GOP between conservatives who demand allegiance to bedrock principles and those concerned with courting swing voters.

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Read more News

› Verified 4 days ago


Pediatrics Doctors in Fontana, CA

Mr. James David Killeen Iii, M.D.
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9961 Sierra Ave, Kaiser Permanente Fontana - Pediatrics, Fontana, CA 92335
Phone: 909-427-6960    
Ramandeep Kaur, M.D
Pediatrics
Medicare: Not Enrolled in Medicare
Practice Location: 16465 Sierra Lakes Pkwy Ste 115, Fontana, CA 92336
Phone: 909-823-8000    Fax: 909-823-8088
Leslie Sison Aquino-peralta, MD
Pediatrics
Medicare: Not Enrolled in Medicare
Practice Location: 9961 Sierra Ave, Fontana, CA 92335
Phone: 909-427-3910    
Connie Lew Cheng, DO
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9961 Sierra Ave, Fontana, CA 92335
Phone: 909-427-3910    
Miss Irene H Odom, M.D.
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9961 Sierra Ave, Fontana, CA 92335
Phone: 909-427-5451    
Mrs. Emma Claire Boda,
Pediatrics
Medicare: Not Enrolled in Medicare
Practice Location: 16465 Sierra Lakes Pkwy Ste 115, Fontana, CA 92336
Phone: 909-823-8000    Fax: 909-823-8088
Eric Mun-kong Wong, MD
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9961 Sierra Ave, Fontana, CA 92335
Phone: 909-427-3910    

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