NPIMap

Organization Active NPI

Brian L Anderson MD a Professional Corporation

  • Family Medicine Physician
  • Redlands, CA
National Provider Identifier
1124707385
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BRIAN L ANDERSON MD A PROFESSIONAL CORPORATION
Practice address
980 Sunset Hills LN
Redlands, CA 92373-6963
Phone
(909) 747-4134
NPI assigned
Jul 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Dr. Brian Leroy Anderson, MDNPI 1396788469
Title
Owner/Ceo
Phone
(909) 747-4134

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

980 Sunset Hills LN
Redlands, CA 92373-6963

Mailing address

980 Sunset Hills LN
Redlands, CA 92373-6963

Other practice location 1

23141 Verdugo Dr Ste 201
Laguna Hills, CA 92653-1341
Phone (949) 215-5055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230928001446 CA Part B Supplier - Clinic/Group Practice 1052765799 Receives reassigned benefits from 9 practitioners
Practice locations: Redlands, CA

National Provider Directory

National Provider Directory

Locations

23141 Verdugo Dr
Laguna Hills, CA 92653

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1124707385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 SUNSET HILLS LN",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 SUNSET HILLS LN",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736963",
            "telephone_number": "909-747-4134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23141 Verdugo Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Laguna Hills",
            "state": "CA",
            "postal_code": "926531341",
            "country_code": "US",
            "telephone_number": "949-215-5055",
            "fax_number": "949-326-5099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIAN L ANDERSON MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "909-747-4134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.