Active NPI
Foothill Community Medical Corporation
- Family Medicine Physician
- Pomona, CA
National Provider Identifier
1104043835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00A666750
- Legal business name
- FOOTHILL COMMUNITY MEDICAL CORPORATION
- Practice address
- 1126 W Mission Blvd
Pomona, CA 91766-1342 - Phone
- (909) 865-2538
- Fax
- (909) 865-2508
- NPI assigned
- Apr 20, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Rafael Carcamo, M.D.
- Title
- President
- Phone
- (909) 865-2538
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00A666750 | CA | Primary |
Addresses
Primary practice location
1126 W Mission Blvd
Pomona, CA 91766-1342
Mailing address
1126 W Mission Blvd
Pomona, CA 91766-1342
Phone (909) 865-2538
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0090561 | Medicaid | CA |
Other names 1
- San Rafael Community Medical Clinic
National Provider Directory
National Provider Directory- Tax ID family
- Foothill Community Medical Corp
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Azusa, CA
- NPI 1881811404
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Azusa, CA
- NPI 1821007055
-
- Foot & Ankle Surgery Podiatrist
- Los Angeles, CA
- NPI 1891720645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1104043835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1126 W MISSION BLVD",
"city": "POMONA",
"state": "CA",
"postal_code": "917661342",
"telephone_number": "909-865-2538",
"fax_number": "909-865-2508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1126 W MISSION BLVD",
"city": "POMONA",
"state": "CA",
"postal_code": "917661342",
"telephone_number": "909-865-2538",
"fax_number": "909-865-2508"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOOTHILL COMMUNITY MEDICAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "CARCAMO",
"authorized_official_first_name": "RAFAEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "909-865-2538",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "CA",
"license": "00A666750",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0090561",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "San Rafael Community Medical Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pomona, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.