Montana Affinity Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MONTANA AFFINITY CLINIC LLC

Practice address

820 N Mountain Ave Ste 103
Upland, CA 91786-0000

Phone

(909) 236-5575

NPI assigned

Oct 23, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Josephine Baisa Montana, M.D.NPI 1417984782

Title

Owner

Phone

(909) 236-5575

Specialties & licenses 1

Addresses

Other names 1

• MONTANA AFFINITY CLINIC LLC Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23048/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.

• Josephine Baisa Montana, M.D

  • Family Medicine Physician
  • Upland, CA
  • NPI 1417984782
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1205435864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N MOUNTAIN AVE STE 103",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864163",
            "telephone_number": "909-236-5575",
            "fax_number": "909-222-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N MOUNTAIN AVE STE 103",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917860000",
            "telephone_number": "909-236-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA AFFINITY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "MONTANA",
        "authorized_official_first_name": "JOSEPHINE",
        "authorized_official_middle_name": "BAISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-236-5575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONTANA AFFINITY CLINIC LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MONTANA AFFINITY CLINIC LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Darrol Monfils, CADCII, ICADC
• Evelyn Monge Perez, LMFT
• Lindsay Monroe, NP
• Josephine Baisa Montana, M.D
• Roxana Montano-Gonzalez
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• Monte Vista Child Care Center Inc
• Monte Vista Child Care Center Inc

• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.