Active NPI
Paramount Professionals Inc
Doing business as Imperial Home Health
- Home Health Agency
- Victorville, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 550000506
- 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, 2016
- 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
- Miss Ginalyn Brown Tayag
- Title
- Cfo
- Phone
- (909) 509-6059
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11132008 | Medicaid | CA |
Other names 1
- Imperial Home Health
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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 Health
- Overall star rating
- Ownership
- Proprietary
- Certified
- Jan 19, 2009
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1067173 | Imperial Home Health | Certificate of waiver | Apr 4, 2027 |
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Asif M Siddiq | 5% Or Greater Direct Ownership Interest | Jan 15, 2014 | 50% |
| Corporate Officer | Jan 14, 2014 | 100% | |
| Eleazar S Tayag | 5% Or Greater Direct Ownership Interest | Jan 15, 2014 | 25% |
| Corporate Officer | Jan 15, 2014 | 25% | |
| Ginalyn B Tayag | 5% Or Greater Direct Ownership Interest | Jan 15, 2014 | 25% |
| Corporate Officer | Jan 15, 2014 | 25% | |
| Debra Lacsamana | Operational/Managerial Control | 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.
-
- Physical Therapist
- Victorville, CA
- NPI 1245355783
5% Or Greater Direct Ownership Interest, Corporate Officer
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.
-
- Physical Therapist
- Victorville, CA
- NPI 1245355783
Affiliated clinicians 12
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Apple Valley, CA
- NPI 1144689647
Home health agency
-
- Infectious Disease Physician
- Victorville, CA
- NPI 1306046123
Home health agency
-
- Family Medicine Physician
- Victorville, CA
- NPI 1093248296
Home health agency
-
- Cardiovascular Disease Physician
- Victorville, CA
- NPI 1588650675
Home health agency
-
- Internal Medicine Physician
- Hesperia, CA
- NPI 1437230190
Home health agency
-
- Internal Medicine Physician
- Victorville, CA
- NPI 1639175490
Home health agency
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.