Blue Shield Promise Health Plan

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BLUE SHIELD PROMISE HEALTH PLAN

Practice address

38440 5TH Street West
Palmdale, CA 93551

Phone

(661) 575-2725

Fax

(661) 273-2139

NPI assigned

Jan 5, 2022

Organization subpart

No

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

Authorized official

Name

Kristen Cerf

Title

President & Ceo Blue Shield Ca Prom

Phone

(510) 607-4376

Specialties & licenses 4

Addresses

Tax ID family

Blue Shield Promise Health Plan3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Blue Shield Promise Healthplan

  • Primary Care Clinic/Center
  • Lancaster, CA
  • NPI 1578214748
  NPD tax ID
• Care1St Health Plan

  • Health Maintenance Organization
  • Monterey Park, CA
  • NPI 1649423856
  NPD tax ID

Locations

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1134880818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38440 5TH STREET WEST",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93551",
            "telephone_number": "661-575-2725",
            "fax_number": "661-273-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38440 5TH STREET WEST",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93551",
            "telephone_number": "661-575-2725",
            "fax_number": "661-273-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SHIELD PROMISE HEALTH PLAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "CERF",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "PRESIDENT & CEO BLUE SHIELD CA PROM",
        "authorized_official_telephone_number": "510-607-4376"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Danielle Blanco
• Cintrilla Rene Bland
• Aaron Bledsoe, PA-C
• Bloom and Birth
• Blue Cornerstone Investments LLC
• Blueprint Development Center
• Jane Denise Bock, PH.D., MFT
• Carol J Bollar, LMFT
• Gabriela Bonilla, PPSC
• Karen Bonilla

• Primary Care Clinic/Center in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.