NPIMap

Organization Active NPI

Pediatric Partners Medical Professional Corporation

  • Pediatrics Physician
  • Menifee, CA
National Provider Identifier
1063500106
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION
Practice address
26900 Newport Rd
Suite 107
Menifee, CA 92584-9222
Phone
(951) 301-5380
Fax
(951) 301-5390
NPI assigned
Oct 11, 2006
Last updated
Mar 29, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Authorized official

Name
Thomas P Mohr, M.D.NPI 1013016781
Title
Chief Executive Officer
Phone
(951) 252-8588

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
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

26900 Newport Rd
Suite 107
Menifee, CA 92584-9222

Mailing address

27699 Jefferson Ave
Suite 300
Temecula, CA 92590-2661
Phone (951) 252-8588

Other identifiers 1

IdentifierTypeStateIssuer
GR0088823OtherCAMEDI-CAL

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners12 organizations share this tax ID, including this one
Part of
Pediatric Partners

Other organizations with this tax ID 11

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

Locations

26900 Newport Rd
Ste 107
Menifee, CA 92584
Phone (951) 301-5380

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1063500106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE",
            "address_2": "SUITE 300",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902661",
            "telephone_number": "951-252-8588",
            "fax_number": "951-252-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26900 NEWPORT RD",
            "address_2": "SUITE 107",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925849222",
            "telephone_number": "951-301-5380",
            "fax_number": "951-301-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION",
        "enumeration_date": "2006-10-11",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "MOHR",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "951-252-8588",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "GR0088823",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menifee, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.