NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • Riverside, CA
National Provider Identifier
1033267992
Registry record updated Jun 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY34444 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
10800 Magnolia Ave
BLDG 3 FL-1 RM 1073
Riverside, CA 92505-3043
Phone
(866) 370-1813
NPI assigned
Jan 8, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Rhonda Lee Polchak
Title
VP Pharmacy Operations & SVCS, Scal
Phone
(562) 658-3510

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Kaiser FDN HLTH Plan Phcy (379 organizations share this tax ID)

Locations

10800 Magnolia Ave
Bldg 3
Riverside, CA 92505
Phone (866) 370-1813

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY34444 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

10800 Magnolia Ave
BLDG 3 FL-1 RM 1073
Riverside, CA 92505-3043

Mailing address

12254 Bellflower Blvd FL 2
Pharmacy Operations
Downey, CA 90242-2804

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
0503070OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1033267992MedicaidCA

Other names 1

NPPES NPI Registry
  • KAISER PERMANENTE PHARMACY 502 Other name

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 16, 2023.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1033267992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12254 BELLFLOWER BLVD FL 2",
            "address_2": "PHARMACY OPERATIONS",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "address_2": "BLDG 3 FL-1 RM 1073",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "866-370-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "POLCHAK",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS & SVCS, SCAL",
        "authorized_official_telephone_number": "562-658-3510"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY34444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0503070",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033267992",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "address_2": "Bldg 3 FL-1 RM 1073",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PHARMACY 502",
            "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 Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.