NPIMap

Organization Active NPI

Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Hemet, CA
National Provider Identifier
1013433465
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice address
3527 W Florida Ave
Hemet, CA 92545-3564
Phone
(877) 608-0044
NPI assigned
Aug 17, 2017
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Dr. Ramin Davidoff
Title
Executive Medical Director
Phone
(877) 608-0044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

3527 W Florida Ave
Hemet, CA 92545-3564

Mailing address

393 E Walnut St FL 3
Pasadena, CA 91188-0011

Other names 1

  • Target Clinic Medical Associates Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000823 CA Part B Supplier - Clinic/Group Practice 6002729175 Receives reassigned benefits from 5,496 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

14305 Meridian Pkwy
Riverside, CA 92518
Phone (951) 251-7300

5225 Canyon Crest Dr
Riverside, CA 92507
Phone (951) 244-4147

Practitioners & affiliated clinicians

Practitioners 797

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 797

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1013433465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST FL 3",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3527 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925453564",
            "telephone_number": "877-608-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "DAVIDOFF",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-608-0044",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3527 W Florida Ave",
            "city": "Hemet",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925453564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Target Clinic Medical Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.