Wilson Gomer M.D. Professional Medical Corporation

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

A50690 Issued in CA

Legal business name

WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION

Practice address

1800 Western Ave Ste 103
San Bernardino, CA 92411

Phone

(909) 887-7427

Fax

(909) 887-7430

NPI assigned

Feb 21, 2018

Last updated

Jun 6, 2018By 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

Dr. Wilson D Gomer, MDNPI 1184656928

Title

President

Phone

(909) 802-9374

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Wilson Gomer, MD

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1184656928
  Authorized official Same address or phone
• Dory Llamado Gomer

  • Nurse Practitioner
  • San Bernardino, CA
  • NPI 1346936671
  NPD
• Perin Gomer Suthakar, MD

  • Specialist
  • San Bernardino, CA
  • NPI 1316967805
  NPD (past)
• Jordan Alexandra Valle, FNP-BC

  • Family Nurse Practitioner
  • Perris, CA
  • NPI 1982533378
  NPD (past)

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1104327543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 WESTERN AVE STE 103",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111352",
            "telephone_number": "909-887-7427",
            "fax_number": "909-887-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 WESTERN AVE STE 103",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-7427",
            "fax_number": "909-887-7430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11340 Mountain View Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923543858",
            "country_code": "US",
            "telephone_number": "909-799-5445",
            "fax_number": "909-799-2006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "GOMER",
        "authorized_official_first_name": "WILSON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-802-9374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "A50690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jermaine L Willis
• Lisette Willis, PMHNP
• Monique Renee Willis
• Wilshiremed Center Inc
• Wilson Dentistry, Inc.
• Wilson Izquierdo MD, Inc
• Brittaney M Wilson-Harris, MD
• Alexandria Coleman Wilson, FNP
• Alyssa Nicole Wilson
• Brooklyn Wilson, ATC

• Health Service Clinic/Center in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.