NPIMap

Organization Active NPI

Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • Yucaipa, CA
National Provider Identifier
1043597743
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
A73011 Issued in CA
Legal business name
SOUTHERN CALIFORNIA EMERGENCY MEDICINE
Practice address
33494 Oak Glen Rd
Yucaipa, CA 92399-2057
Phone
(909) 797-8900
NPI assigned
Nov 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Authorized official

Name
Mrs. Jennifer Brunk
Title
Credentialing Manager
Phone
(909) 596-6349

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X A73011 CA Primary

Addresses

Primary practice location

33494 Oak Glen Rd
Yucaipa, CA 92399-2057

Mailing address

1407 Foothill Blvd # 306
La Verne, CA 91750-3451

Other names 1

  • Yucaipa Urgent Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090604000499 CA Part B Supplier - Clinic/Group Practice 8628128196 Receives reassigned benefits from 89 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hemet, CA; Moreno Valley, CA; Norco, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; Yucaipa, CA; Colton, CA

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

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1043597743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 FOOTHILL BLVD # 306",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33494 OAK GLEN RD",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992057",
            "telephone_number": "909-797-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA EMERGENCY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-08",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "BRUNK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "909-596-6349",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "A73011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yucaipa Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yucaipa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.