Southern California Primary Medical Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

A91216 Issued in CA

Legal business name

SOUTHERN CALIFORNIA PRIMARY MEDICAL INC

Practice address

19341 Bear Valley Rd Ste 101
Apple Valley, CA 92308

Phone

(760) 810-7778

Fax

(760) 810-7780

NPI assigned

Jul 18, 2011

Organization subpart

No

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

Authorized official

Name

Ashish Malhotra, M.D.NPI 1679583744

Title

Owner

Phone

(760) 810-7778

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashish Malhotra, M.D.

  • Family Medicine Physician
  • Apple Valley, CA
  • NPI 1679583744

  Geriatric Medicine

  Medicare reassignment NPD Authorized official
• Randi Celeste Edwards

  • Family Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1093208316
  NPD (past)
• Casey Jean Thompson

  • Physician Assistant
  • Rancho Cucamonga, CA
  • NPI 1528416005
  NPD (past)

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533513600000",
    "number": "1043508559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8237 ROCHESTER AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300717",
            "telephone_number": "909-477-3310",
            "fax_number": "909-477-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19341 BEAR VALLEY RD STE 101",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92308",
            "telephone_number": "760-810-7778",
            "fax_number": "760-810-7780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8237 Rochester Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917300717",
            "country_code": "US",
            "telephone_number": "909-477-3310",
            "fax_number": "909-477-3320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PRIMARY MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2018-08-06",
        "status": "A",
        "authorized_official_last_name": "MALHOTRA",
        "authorized_official_first_name": "ASHISH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-810-7778",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A91216",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A91216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Geriatric Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.