NPIMap

Organization Active NPI

Vituity Physician Services PC

  • Family Medicine Physician
  • Fontana, CA
National Provider Identifier
1124884176
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VITUITY PHYSICIAN SERVICES PC
Practice address
16888 Baseline Ave
Fontana, CA 92336-2083
Phone
(855) 422-8029
NPI assigned
Feb 27, 2024
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Authorized official

Name
David Andrew BirdsallNPI 1164445615
Title
Chief Operations Officer
Phone
(510) 350-2600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

16888 Baseline Ave
Fontana, CA 92336-2083

Mailing address

2100 Powell St Ste 400
Emeryville, CA 94608-1872

Other practice location 1

850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (855) 422-8029

Other practice location 2

800 E Lugonia Ave Ste F
Redlands, CA 92374-2550
Phone (800) 722-4777

Other practice location 3

1499 E Highland Ave
San Bernardino, CA 92404-4611
Phone (855) 422-8029

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240506004038 CA Part B Supplier - Clinic/Group Practice 0749620888 Receives reassigned benefits from 87 practitioners
Practice locations: San Bernardino, CA; Rialto, CA; Redlands, CA; Fontana, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 89

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.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1124884176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST STE 400",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16888 BASELINE AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362083",
            "telephone_number": "855-422-8029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 E Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923765230",
            "country_code": "US",
            "telephone_number": "855-422-8029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E Lugonia Ave Ste F",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923742550",
            "country_code": "US",
            "telephone_number": "800-722-4777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1499 E Highland Ave",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924044611",
            "country_code": "US",
            "telephone_number": "855-422-8029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITUITY PHYSICIAN SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "BIRDSALL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "510-350-2600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.