NPIMap

Organization Active NPI

San Gorgonio Memorial Health Care District

Doing business as San Gorgonio Memorial Medical Clinic

  • Multi-Specialty Clinic/Center
  • Banning, CA
National Provider Identifier
1194243642
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT
Doing business as
San Gorgonio Memorial Medical Clinic
Practice address
264 N Highland Springs Ave Ste 3D
Banning, CA 92220-3085
Phone
(951) 846-2877
Fax
(951) 846-2876
NPI assigned
Sep 5, 2017
Last updated
Jan 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Authorized official

Name
Mrs. Angela Brady, DNP, CENP, APRN, CNPI 1689098832
Title
Chief Nursing Executive/VP
Phone
(517) 692-1859

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

264 N Highland Springs Ave Ste 3D
Banning, CA 92220-3085

Mailing address

264 N Highland Springs Ave Ste 3D
Banning, CA 92220-3085
Phone (951) 769-4897

Other names 1

  • San Gorgonio Memorial Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019001354 CA Part B Supplier - Clinic/Group Practice 0749556793 Receives reassigned benefits from 10 practitioners
Practice locations: Banning, CA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Gorgonio Memorial HospitalBanning, CA, CCN 050054 Hospital Operational/Managerial Control Jul 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1194243642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 N HIGHLAND SPRINGS AVE STE 3D",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203085",
            "telephone_number": "951-769-4897",
            "fax_number": "951-848-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 N HIGHLAND SPRINGS AVE STE 3D",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203085",
            "telephone_number": "951-846-2877",
            "fax_number": "951-846-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GORGONIO MEMORIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-05",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF NURSING EXECUTIVE/VP",
        "authorized_official_telephone_number": "517-692-1859",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, CENP, APRN, C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Gorgonio Memorial Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Banning, CA

Sources for this page

Verify at the official NPI Registry.