NPIMap

Organization Active NPI

Mission Grove Medical Corporation

Doing business as Urgent Care Clinic

  • Pulmonary Disease Physician
  • Riverside, CA
National Provider Identifier
1205224417
Registry record updated Sep 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
MISSION GROVE MEDICAL CORPORATION
Doing business as
Urgent Care Clinic
Practice address
191 E Alessandro Blvd # 9a
Riverside, CA 92508-5095
Phone
(951) 780-3300
Fax
(951) 780-3303
NPI assigned
Dec 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2026

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

Authorized official

Name
Sibonisiwe Moyo JohnsonNPI 1255872719
Title
Ao
Phone
(951) 780-3300

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
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary
Urgent Care Clinic/Center 261QU0200X A39116 CA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

191 E Alessandro Blvd # 9a
Riverside, CA 92508-5095

Mailing address

191 E Alessandro Blvd # 9a
Riverside, CA 92508-5095
Phone (951) 780-3300

Other names 1

  • URGENT CARE CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150624000811 CA Part B Supplier - Clinic/Group Practice 3971814484 Receives reassigned benefits from 8 practitioners
Practice locations: Riverside, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1205224417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 E ALESSANDRO BLVD # 9A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085095",
            "telephone_number": "951-780-3300",
            "fax_number": "951-780-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 E ALESSANDRO BLVD # 9A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085095",
            "telephone_number": "951-780-3300",
            "fax_number": "951-780-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION GROVE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-23",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SIBONISIWE",
        "authorized_official_middle_name": "MOYO",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "951-780-3300"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "A39116",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "URGENT CARE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; 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.