NPIMap

Organization Active NPI

Provident Hospitalist Associates, a Professional Medical Corporation

  • Internal Medicine Physician
  • Corona, CA
National Provider Identifier
1083998173
Registry record updated Oct 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A63079 Issued in CA
Legal business name
PROVIDENT HOSPITALIST ASSOCIATES, A PROFESSIONAL MEDICAL CORPORATION
Practice address
800 S Main St
Corona, CA 92882-3420
Phone
(951) 737-4343
NPI assigned
Oct 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2011

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

Authorized official

Name
Sunil Sujan, M.D.NPI 1598740474
Title
Ceo
Phone
(310) 351-4566

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A63079 CA Primary

Addresses

Primary practice location

800 S Main St
Corona, CA 92882-3420

Mailing address

1191 Magnolia Ave
Suite D #248
Corona, CA 92879-3215
Phone (951) 736-6325

National Provider Directory

National Provider Directory

Locations

1191 Magnolia Ave
Ste D
Corona, CA 92879

1191 Magnolia Ave
#D248
Corona, CA 92879

Practitioners & affiliated clinicians

Practitioners 6

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": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1083998173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 MAGNOLIA AVE",
            "address_2": "SUITE D #248",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793215",
            "telephone_number": "951-736-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S MAIN ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823420",
            "telephone_number": "951-737-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HOSPITALIST ASSOCIATES, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "SUJAN",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-351-4566",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A63079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.