NPIMap

Organization Active NPI

Home Care MD Medical Group

  • Primary Care Nurse Practitioner
  • West Covina, CA
National Provider Identifier
1023644556
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
HOME CARE MD MEDICAL GROUP
Doing business as
Home Care MD Medical Group
Practice address
100 N Barranca St # 900-J
West Covina, CA 91791-1637
Phone
(626) 377-7608
Fax
(626) 206-0553
NPI assigned
Mar 16, 2020
Last updated
Jun 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Authorized official

Name
Shylee Bautista Tiamson, FNPNPI 1053779322
Title
Nurse Practitioner
Phone
(310) 292-0117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Family Nurse Practitioner 363LF0000X
Primary Care Nurse Practitioner 363LP2300X Primary
Family Medicine Physician 207Q00000X
Occupational Medicine Physician 2083X0100X

Addresses

Primary practice location

100 N Barranca St # 900-J
West Covina, CA 91791-1637

Mailing address

100 N Barranca St # 900-J
West Covina, CA 91791-1637
Phone (626) 377-7608

Other practice location 1

2785 Pacific Coast Hwy Ste E241
Torrance, CA 90505-7066
Phone (626) 377-7608

Other names 1

  • Home Care MD Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200411000284 CA Part B Supplier - Clinic/Group Practice 8921437088 Receives reassigned benefits from 26 practitioners
Practice locations: West Covina, CA

National Provider Directory

National Provider Directory

Locations

2785 Pacific Coast Hwy
Ste E241
Torrance, CA 90505
Phone (626) 377-7608

100 N Barranca St
#900J
West Covina, CA 91791
Phone (310) 292-0117

100 N Barranca St
Ste 900
West Covina, CA 91791
Phone (626) 206-0523

100 N Barranca St
Ste 900J
West Covina, CA 91791
Phone (626) 377-7608

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1023644556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N BARRANCA ST # 900-J",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911637",
            "telephone_number": "626-377-7608",
            "fax_number": "626-206-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N BARRANCA ST # 900-J",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911637",
            "telephone_number": "626-377-7608",
            "fax_number": "626-206-0553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2785 Pacific Coast Hwy Ste E241",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905057066",
            "country_code": "US",
            "telephone_number": "626-377-7608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOME CARE MD MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "TIAMSON",
        "authorized_official_first_name": "SHYLEE",
        "authorized_official_middle_name": "BAUTISTA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "310-292-0117",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Home Care MD Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.