DR. WILLIAM C INCISO (PA-C, PHD) – Physician Assistant, NPI 1407050289

DR. WILLIAM C INCISO (PA-C, PHD) is a healthcare provider. based in San bernardino, California. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C, PHD. They hold a License No. PA 15861 (CA). The NPI Number for DR. WILLIAM C INCISO (PA-C, PHD) is 1407050289

Main info

Male
26 Years Of Experience
Accepts Medicare Assignment
Name
DR. WILLIAM C INCISO (PA-C, PHD)
NPI
1407050289
Phone
(909) 881-7605
Address
2101 N WATERMAN AVE
Enumeration Date
13 June 2007
Last Update Date
15 March 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9095964879
Graduation Year
2000 (26 years ago)
PAC ID
7618198789
Group Practice PAC ID
2668757055
Professional Enrollment ID
I20141015001467
Address ID
CA917503329LA1234XBLVD300

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness85
Years active:18State licenses:1Other namesUpdated within 12 months

10,570 PHYSICIAN ASSISTANT in CA

Provider Addresses for DR. WILLIAM C INCISO (PA-C, PHD)

  • 2101 N WATERMAN AVE

    SAN BERNARDINO, CA 924044836

    Phone: (909) 881-7605

    Type: Location

  • 11855, Briarrose Lane, Chino, San Bernardino County, California, 91710, United States

    CHINO, CA 917102040

    Phone: (909) 455-2368

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2014-10-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20141015001467IPhysician AssistantCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 92404)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2668757055View full group profile

Reviews

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Frequently asked questions

Can I verify DR. WILLIAM C INCISO (PA-C, PHD) with an NPI only?
You can start verification with NPI 1407050289 for DR. WILLIAM C INCISO (PA-C, PHD), then check state licensing separately.
Does CMS list DR. WILLIAM C INCISO (PA-C, PHD) as active?
Yes — DR. WILLIAM C INCISO (PA-C, PHD) is active in the NPI listing used on this page.
What is DR. WILLIAM C INCISO (PA-C, PHD) best known for clinically?
Directory data describes DR. WILLIAM C INCISO (PA-C, PHD) with Physician Assistant. Clinical services aligned with this taxonomy classification.
Where is DR. WILLIAM C INCISO (PA-C, PHD) based?
DR. WILLIAM C INCISO (PA-C, PHD) is tied to San Bernardino, California in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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