NPIMap

Organization Active NPI

Riverside Faculty Medical Group Inc

  • Internal Medicine Physician
  • Moreno Valley, CA
National Provider Identifier
1124032461
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RIVERSIDE FACULTY MEDICAL GROUP INC
Practice address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone
(951) 486-5700
Fax
(951) 486-5705
NPI assigned
Jul 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

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

Authorized official

Name
Mr. Daniel Kim, M.D.NPI 1295769651
Title
MD/President
Phone
(951) 486-5701

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Mailing address

PO Box 7270
Moreno Valley, CA 92552-7270
Phone (951) 486-5700

Other identifiers 1

IdentifierTypeStateIssuer
GR0061940MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070329000259 CA Part B Supplier - Clinic/Group Practice 9436253515 Receives reassigned benefits from 110 practitioners
Practice locations: Moreno Valley, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 111

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

View all 111

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1124032461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7270",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925527270",
            "telephone_number": "951-486-5700",
            "fax_number": "951-486-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "951-486-5700",
            "fax_number": "951-486-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE FACULTY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "951-486-5701",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0061940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.