Organization Active NPI

Paramount Professionals Inc

Doing business as Imperial Home Health

  • Home Health Agency
  • Victorville, CA
National Provider Identifier
1104067578
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
550000506 Issued in CA
Legal business name
PARAMOUNT PROFESSIONALS INC
Doing business as
Imperial Home Health
Practice address
16484 Victor St.
Victorville, CA 92395-3726
Phone
(760) 951-6688
Fax
(760) 459-2268
NPI assigned
Mar 16, 2009
Last updated
Nov 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Authorized official

Name
Miss Ginalyn Brown Tayag
Title
Cfo
Phone
(909) 509-6059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 550000506 CA Primary

Addresses

Primary practice location

16484 Victor St.
Victorville, CA 92395-3726

Mailing address

16484 Victor St.
Victorville, CA 92395-3726
Phone (760) 951-6688

Other identifiers 1

IdentifierTypeStateIssuer
11132008MedicaidCA

Other names 1

  • Imperial Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050518001287 CA Part A Provider - Home Health Agency 1951342039 Practice locations: Victorville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104067578. Details of each certification follow.

Home health agency certification: CCN 059033

Legal name
PARAMOUNT PROFESSIONALS, INC.
Doing business as
IMPERIAL HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 19, 2009
Last certification
Mar 16, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 9, 2003 in CA
Enrollment address
16484 Victor St
Victorville, CA 92395-3918

Care Compare: Home health agency

Medicare Care Compare
Listed as
Imperial Home HealthCCN 059033 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jan 19, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
05D1067173Imperial Home Health16484 Victor Street, Victorville, CA 92395Certificate of waiverApr 4, 2027

National Provider Directory

National Provider Directory

Locations

1080 S La Cienega Blvd
Ste 210
Los Angeles, CA 90035
Phone (310) 657-8771

12550 Hesperia Rd
Ste 200
Victorville, CA 92395
Phone (760) 245-8858

15366 Eleventh St
Ste O
Victorville, CA 92395
Phone (442) 327-9500

15415 W Sand St
Ste 105
Victorville, CA 92392
Phone (760) 951-6688

15500 W Sand St
Ste 5
Victorville, CA 92392
Phone (760) 245-8858

16484 Victor St
Victorville, CA 92395
Phone (760) 951-6688

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Asif M Siddiq Individual 5% Or Greater Direct Ownership InterestOwner Jan 15, 2014 50%
Corporate OfficerBoard Member Jan 14, 2014 100%
Eleazar S Tayag Individual 5% Or Greater Direct Ownership Interest Jan 15, 2014 25%
Corporate OfficerBoard Member Jan 15, 2014 25%
Ginalyn B Tayag Individual 5% Or Greater Direct Ownership InterestOwner Jan 15, 2014 25%
Corporate OfficerBoard Member Jan 15, 2014 25%
Debra Lacsamana Individual Operational/Managerial ControlManager Jan 15, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1104067578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16484 VICTOR ST.",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953726",
            "telephone_number": "760-951-6688",
            "fax_number": "760-459-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16484 VICTOR ST.",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953726",
            "telephone_number": "760-951-6688",
            "fax_number": "760-459-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARAMOUNT PROFESSIONALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "TAYAG",
        "authorized_official_first_name": "GINALYN",
        "authorized_official_middle_name": "BROWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-509-6059",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "550000506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11132008",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imperial Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.