NPIMap

Organization Active NPI

Paragon Medical Alliance LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Reno, NV
National Provider Identifier
1063236461
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
PARAGON MEDICAL ALLIANCE LLC
Practice address
3690 Grant Dr Unit L2
Reno, NV 89509-5476
Phone
(775) 527-3621
NPI assigned
Nov 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Minmin Song
Title
Owner/Executive Officer
Phone
(775) 527-3621

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

3690 Grant Dr Unit L2
Reno, NV 89509-5476

Mailing address

3690 Grant Dr Unit L2
Reno, NV 89509-5476
Phone (775) 527-3621

Other names 1

  • PARAGON MEDICAL PRACTICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250109001273 NV Part B Supplier - Clinic/Group Practice 3072041714 Receives reassigned benefits from 3 practitioners
Practice locations: Reno, NV

National Provider Directory

National Provider Directory

Locations

3690 Grant Dr
Unit L2
Reno, NV 89509
Phone (775) 277-3747

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1063236461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3690 GRANT DR UNIT L2",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095476",
            "telephone_number": "775-527-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 GRANT DR UNIT L2",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095476",
            "telephone_number": "775-527-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARAGON MEDICAL ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "MINMIN",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "775-527-3621"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARAGON MEDICAL PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.