Park Sierra Medical Clinic Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PARK SIERRA MEDICAL CLINIC INC

Practice address

1023 S Mount Vernon Ave Ste a
Colton, CA 92324-4202

Phone

(909) 533-4443

Fax

(909) 533-4483

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Anil Donald Mall, MDNPI 1285656900

Title

Owner

Phone

(909) 533-4443

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1319/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Anil D Mall, M.D.

  • Family Medicine Physician
  • Colton, CA
  • NPI 1285656900
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1184833428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 S MOUNT VERNON AVE STE A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244202",
            "telephone_number": "909-533-4443",
            "fax_number": "909-533-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 S MOUNT VERNON AVE STE A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244202",
            "telephone_number": "909-533-4443",
            "fax_number": "909-533-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK SIERRA MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "MALL",
        "authorized_official_first_name": "ANIL",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-533-4443",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oliver Pantaleon
• Ledric Dolf Pineo Pantan
• Chloe Noula Pappas
• Edith Domitila Paredes
• Kristina Paris
• Amelia Bora Park, DO
• Haeyoung Park
• Hannah Park, DO
• James Park, MD
• Ji Yeon Park, DO

• Clinic/Center in Colton, CA
• Providers in Colton, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.