Active NPI
Fountain Valley Group Services PC
- Hospitalist Physician
- Indio, CA
National Provider Identifier
1013310309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- Legal business name
- FOUNTAIN VALLEY GROUP SERVICES PC
- Practice address
- 47111 Monroe St
Indio, CA 92201-6739 - Phone
- (760) 347-6191
- NPI assigned
- Oct 1, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kim Larsen
- Title
- VP, Credentialing
- Phone
- (770) 874-5400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | Primary |
Addresses
Primary practice location
47111 Monroe St
Indio, CA 92201-6739
Mailing address
PO Box 20441
Belfast, ME 04915-4099
Phone (770) 874-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150417000931 | CA | Part B Supplier - Clinic/Group Practice | 9931427382 |
Receives reassigned benefits from 57 practitioners Practice locations: Indio, CA |
National Provider Directory
National Provider Directory- Tax ID family
- Fountain Valley Group Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Critical Care Medicine (Internal Medicine) Physician
- Indio, CA
- NPI 1194670349
Practitioners & affiliated clinicians
Practitioners 58
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Palm Springs, CA
- NPI 1609368935
CA, Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412121600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1786579200000",
"number": "1013310309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20441",
"city": "BELFAST",
"state": "ME",
"postal_code": "049154099",
"telephone_number": "770-874-5400",
"fax_number": "770-874-5483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47111 MONROE ST",
"city": "INDIO",
"state": "CA",
"postal_code": "922016739",
"telephone_number": "760-347-6191"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOUNTAIN VALLEY GROUP SERVICES PC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-01",
"last_updated": "2026-08-13",
"certification_date": "2026-08-13",
"status": "A",
"authorized_official_last_name": "LARSEN",
"authorized_official_first_name": "KIM",
"authorized_official_title_or_position": "VP, CREDENTIALING",
"authorized_official_telephone_number": "770-874-5400"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Hospitalist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.