NPIMap

Organization Active NPI

Inland Physicians Service Inc

Doing business as Inland Region Medical Group

  • Family Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1083724850
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INLAND PHYSICIANS SERVICE INC
Doing business as
Inland Region Medical Group
Practice address
9089 Baseline Road
Suite 100
Rancho Cucamonga, CA 91730
Phone
(909) 483-0505
Fax
(909) 483-0508
NPI assigned
Aug 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas Allen Woodbury, DONPI 1609878115
Title
Managing Physican Partner
Phone
(909) 483-0505

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

9089 Baseline Road
Suite 100
Rancho Cucamonga, CA 91730

Mailing address

9089 Baseline Road
Suite 100
Rancho Cucamonga, CA 91730
Phone (909) 483-0505

Other identifiers 2

IdentifierTypeStateIssuer
GR0061231MedicaidCA
DA1449OtherCAMEDICARE RAILROAD

Other names 1

  • Inland Region Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119001002 CA Part B Supplier - Clinic/Group Practice 2769386093 Receives reassigned benefits from 11 practitioners
Practice locations: Upland, CA; San Bernradino, CA; San Bernardino, CA; San Bernadino, CA; Montclair, CA; Riverside, CA; Rialto, CA; Redlands, CA…
O20040109001105 CA Part B Supplier - Clinic/Group Practice 2769386093 Receives reassigned benefits from 11 practitioners
Practice locations: Claremont, CA; Pomona, CA; Rancho Cucamonga, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0876601Inland Region Medical Group9089 Baseline Road, Suite 100-a, Rancho Cucamonga, CA 91730Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory

Locations

9089 Base Line Rd
Ste 100
Rch Cucamonga, CA 91730
Phone (909) 483-0505

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 & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083724850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9089 BASELINE ROAD",
            "address_2": "SUITE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-483-0505",
            "fax_number": "909-483-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9089 BASELINE ROAD",
            "address_2": "SUITE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-483-0505",
            "fax_number": "909-483-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND PHYSICIANS SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOODBURY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGING PHYSICAN PARTNER",
        "authorized_official_telephone_number": "909-483-0505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0061231",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA1449",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inland Region Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.