Individual provider Active NPI

Mohammadreza Ghayuri, MD

  • Obstetrics & Gynecology Physician
  • Colton, CA
National Provider Identifier
1073711156
Registry record updated Feb 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
C54829 Issued in CA
Practice address
400 N Pepper Ave
Colton, CA 92324-1801
Phone
(909) 580-3470
Fax
(909) 580-3289
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 35.090050 OH
Obstetrics & Gynecology Physician 207V00000X C54829 CA Primary

Addresses

Primary practice location

400 N Pepper Ave
Colton, CA 92324-1801

Mailing address

400 N Pepper Ave
Colton, CA 92324-1801
Phone (909) 580-3470

Other identifiers 1

IdentifierTypeStateIssuer
1073711156MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130322000329 CA Practitioner - Obstetrics/Gynecology 1951499045 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Obstetrics and Gynecology Medical Group IncGroup PAC ID 7113911470, 10 clinicians

Practice addresses (Care Compare)

400 N Pepper Ave
2Mob206
Colton, CA 92324-1801
Phone (909) 580-2270

Hospital & facility affiliations

  • Arrowhead Regional Medical Center Hospital, Colton, CA, CCN 050245

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C54829CAMDObstetrics & Gynecology Physician
35.090050OHMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Obstetrics & Gynecology Medical Group, Inc. Obstetrics & Gynecology CurrentSince Mar 1, 2019 Accepting new patients
Senior'S Choice Medical Group, Inc. CurrentSince Mar 1, 2019 Accepting new patients
San Marcos Medical Group Inc Obstetrics & Gynecology CurrentSince Mar 23, 2014 Accepting new patients
Mommy and Me Medical Group, Inc. Obstetrics & Gynecology CurrentSince Mar 1, 2019 Accepting new patients
Clinic Regional Physicians LLC Obstetrics & Gynecology Past Accepting new patients
The Cleveland Clinic Foundation Past Accepting new patients
Reuben C Castillo, Professional Corporation Past Accepting new patients

Locations

400 N Pepper Ave
Colton, CA 92324
Phone (909) 580-1800

400 N Pepper Ave
#2
Colton, CA 92324
Phone (909) 580-2270

7965 Sierra Ave
Fontana, CA 92336
Phone (909) 356-4459

14980 Summit Ave
Ste 230
Fontana, CA 92336
Phone (909) 803-1160

498 W 4th St
Perris, CA 92570
Phone (951) 657-5441

416 W Foothill Blvd
Rialto, CA 92376
Phone (909) 421-0493

4190 Chicago Ave
Riverside, CA 92507
Phone (951) 632-2106

7576 Sterling Ave
Ste Cd
San Bernardino, CA 92410
Phone (909) 381-8983

742 W Highland Ave
Sn Bernrdno, CA 92405
Phone (909) 881-7320

1574 W Base Line St
Ste 107
Sn Bernrdno, CA 92411
Phone (909) 386-1880

Interoperability endpoints

  • Direct secure messaging: mohamadreza.ghayuri.p2@direct.mpmccorp.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519689600000",
    "number": "1073711156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-3470",
            "fax_number": "909-580-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-3470",
            "fax_number": "909-580-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAYURI",
        "first_name": "MOHAMMADREZA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2018-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35.090050",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "C54829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073711156",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.