NPIMap

Organization Active NPI

Central Occupational Medicine Providers - Ontario, a Medical Corporati

  • Occupational Medicine Clinic/Center
  • Moreno Valley, CA
National Provider Identifier
1104184860
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
CENTRAL OCCUPATIONAL MEDICINE PROVIDERS - ONTARIO, A MEDICAL CORPORATI
Practice address
13800 Heacock St
Suite C136
Moreno Valley, CA 92553-3339
Phone
(951) 656-6009
Fax
(951) 656-6010
NPI assigned
May 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Authorized official

Name
Mr. Gregory Joseph Speer
Title
Administrator
Phone
(951) 222-2206

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X A48324 CA
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X A43039 CA
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 20A5982 CA
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 48512 CA
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X G70519 CA
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X 20A9190 CA
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X G72529 CA
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

13800 Heacock St
Suite C136
Moreno Valley, CA 92553-3339

Mailing address

4300 Central Ave
Riverside, CA 92506-2918
Phone (951) 222-2206

Other names 1

  • COMP Other name

National Provider Directory

National Provider Directory
Tax ID family
Central Occupational Medicine Providers - Ontario a Medical Corporati6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
05D2161544Central Occupational Medicine Providers13800 Heacock Avenue, Suite C-136, Moreno Valley, CA 92553Certificate of waiverFeb 4, 2027

NPI Registry JSON

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1104184860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CENTRAL AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062918",
            "telephone_number": "951-222-2206",
            "fax_number": "951-222-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST",
            "address_2": "SUITE C136",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533339",
            "telephone_number": "951-656-6009",
            "fax_number": "951-656-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OCCUPATIONAL MEDICINE PROVIDERS - ONTARIO, A MEDICAL CORPORATI",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "SPEER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-222-2206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A48324",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43039",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5982",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "48512",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G70519",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A9190",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G72529",
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.