Paulus Santoso MD a Professional Corporation

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

A85478 Issued in CA

Legal business name

PAULUS SANTOSO MD A PROFESSIONAL CORPORATION

Practice address

6969 Brockton Ave
Suite a-B
Riverside, CA 92506-3809

Phone

(951) 530-8989

Fax

(951) 530-8877

NPI assigned

Nov 12, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Paulus Liem Santoso, M.D.NPI 1154329373

Title

Ceo

Phone

(951) 530-8989

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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 7

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.

• Paulus L. Santoso, M.D.

  • Obstetrics Physician
  • Riverside, CA
  • NPI 1154329373
  Medicare reassignment NPD Authorized official
• Jennifer Vong, DO

  • Obstetrics & Gynecology Physician
  • Corona, CA
  • NPI 1952669715

  Single Specialty

  Medicare reassignment NPD
• Lauren Elizabeth Adkins, FNP-C

  • Family Nurse Practitioner
  • Riverside, CA
  • NPI 1033954128
  NPD (past)
• Gloria Lynn Duarte, MSN, WHNP, RN

  • Obstetrics & Gynecology Nurse Practitioner
  • Riverside, CA
  • NPI 1659541738
  NPD (past)
• Jasmine Yuzana Jaffe, N.P.

  • Nurse Practitioner
  • Riverside, CA
  • NPI 1124242136
  NPD (past)
• Myrtle Jean Krushall, NP

  • Nurse Practitioner
  • Riverside, CA
  • NPI 1396957932
  NPD (past)
• Elizabeth Ann Ramirez, MD

  • Obstetrics & Gynecology Physician
  • Riverside, CA
  • NPI 1225268501
  NPD (past)

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

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1093042970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6969 BROCKTON AVE",
            "address_2": "SUITE A-B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063809",
            "telephone_number": "951-530-8989",
            "fax_number": "951-530-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6969 BROCKTON AVE",
            "address_2": "SUITE A-B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063809",
            "telephone_number": "951-530-8989",
            "fax_number": "951-530-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULUS SANTOSO MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-12",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "SANTOSO",
        "authorized_official_first_name": "PAULUS",
        "authorized_official_middle_name": "LIEM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-530-8989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CA",
            "license": "A85478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A854780",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "00A854780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lijia Saji Paul
• Peter Paul, M.D.
• Rochalla Paul
• Louis Paulos
• Taylor Jean Paulson, LMFT
• Gabriel Seth Pavelsky, RDA
• Ashanty Pavia
• Pavisch Treatment Centers, LLC
• Ashley Nicole Pawling
• Lakeisha Paxton

• Obstetrics Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Obstetrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.