Organization Active NPI

Arthritis Center of Riverside Medical Corporation

  • Rheumatology Physician
  • Riverside, CA
National Provider Identifier
1013076850
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
A35128 Issued in CA
Legal business name
ARTHRITIS CENTER OF RIVERSIDE MEDICAL CORPORATION
Practice address
11725 Slate Ave
Suite 100
Riverside, CA 92505-7100
Phone
(951) 352-1700
Fax
(951) 352-9110
NPI assigned
Dec 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jessica Henderson
Title
Billing Manager
Phone
(951) 352-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X A35128 CA Primary

Addresses

Primary practice location

11725 Slate Ave
Suite 100
Riverside, CA 92505-7100

Mailing address

11725 Slate Ave
Suite 100
Riverside, CA 92505-7100
Phone (951) 352-1700

Other identifiers 1

IdentifierTypeStateIssuer
05D0575313OtherCACLIA # ARTHRITIS CENTER

Other names 1

  • Arthritis Center of Riverside Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080612000488 CA Part B Supplier - Clinic/Group Practice 4981775319 Receives reassigned benefits from 4 practitioners
Practice locations: Riverside, CA

National Provider Directory

National Provider Directory

Locations

11725 Slate Ave
Ste 200
Riverside, CA 92505

4000 14th St
Ste 511
Riverside, CA 92501
Phone (909) 788-0850

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1013076850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11725 SLATE AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057100",
            "telephone_number": "951-352-1700",
            "fax_number": "951-352-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11725 SLATE AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057100",
            "telephone_number": "951-352-1700",
            "fax_number": "951-352-9110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARTHRITIS CENTER OF RIVERSIDE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-07",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "951-352-1700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "CA",
            "license": "A35128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA # ARTHRITIS CENTER",
            "identifier": "05D0575313",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arthritis Center of Riverside",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.