Trident Medical Group Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRIDENT MEDICAL GROUP INC.

Practice address

18564 US Highway 18 Ste 103&104
Apple Valley, CA 92307-2312

Phone

(760) 242-9262

NPI assigned

Aug 14, 2023

Last updated

Mar 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nyra Khetarpal, MDNPI 1982999116

Title

President

Phone

(484) 557-9511

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

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.

• Nyra Khetarpal, M.D.

  • Internal Medicine Physician
  • Apple Valley, CA
  • NPI 1982999116
  Medicare reassignment Care Compare group NPD Authorized official
• Nina Gloria Suh, PA-C

  • Physician Assistant
  • Apple Valley, CA
  • NPI 1104152966
  Medicare reassignment Care Compare group NPD
• Maria Linnette Gutierrez, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Apple Valley, CA
  • NPI 1740179803
  Medicare reassignment NPD
• Ruby K Jhaj, M.D.

  • Internal Medicine Physician
  • Hesperia, CA
  • NPI 1962841940
  NPD (past)
• Darline Karen Padilla, F.N.P-C

  • Family Nurse Practitioner
  • Victorville, CA
  • NPI 1558373183
  NPD (past)

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1093498230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 RIVERSIDE DR",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923075335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18564 US HIGHWAY 18 STE 103&104",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072312",
            "telephone_number": "760-242-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "KHETARPAL",
        "authorized_official_first_name": "NYRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-557-9511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trans-Medica, Inc.
• Tree of Life Counseling, a Licensed Clinical Social Worker Corporation
• Treehouse Counseling and Wellness Center (Kimberly Lussier, LCSW, Inc.)
• Tri City RX Pharmacy, Inc.
• Tri-Cities Physical Therapy
• Trika Medical Inc
• Trinity Youth Services
• Trinity Youth Services
• Trinity Youth Services
• Triumphant Life

• Internal Medicine Physician in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.