NPIMap

Organization Active NPI

MGM Physician Assistant Inc

Doing business as La Casa Wound Specialist

  • Surgical Physician Assistant
  • Riverside, CA
National Provider Identifier
1023871779
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
MGM PHYSICIAN ASSISTANT INC
Doing business as
La Casa Wound Specialist
Practice address
1525 3Rd St Ste 205
Riverside, CA 92507-9000
Phone
(310) 810-6554
NPI assigned
Feb 5, 2024
Last updated
Dec 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Authorized official

Name
Gina Habeeb, PANPI 1801386149
Title
Ceo
Phone
(951) 788-2224

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

1525 3Rd St Ste 205
Riverside, CA 92507-9000

Mailing address

1525 3Rd St Ste 205
Riverside, CA 92507-9000

Other names 1

  • La Casa Wound Specialist Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240324000090 CA Part B Supplier - Clinic/Group Practice 5890132096 Receives reassigned benefits from 19 practitioners
Practice locations: Colton, CA; Riverside, CA

National Provider Directory

National Provider Directory

Locations

1525 3rd St
Ste 205
Riverside, CA 92507
Phone (310) 619-7370

609 Deep Valley Dr
Fl 2
Rolling Hills Estates, CA 90274

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1023871779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 3RD ST STE 205",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925079000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 3RD ST STE 205",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925079000",
            "telephone_number": "310-810-6554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGM PHYSICIAN ASSISTANT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-05",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "HABEEB",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-788-2224",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Casa Wound Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 3, 2025; 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.