Randy Steven Yergenson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52591 Issued in CA

Practice address

5957 W Ramsey St
Banning, CA 92220-3058

Phone

(951) 845-0313

NPI assigned

Jun 12, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ryergenson31040@epiclp.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beaver Medical Group P C

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment Care Compare group NPD
• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment NPD
• Apex Emergency Medical Group, Inc.

  • Emergency Medicine Physician
  • Hemet, CA
  • NPI 1265711089
  Medicare reassignment
• Temecula Valley Emergency Medical Associates

  • Specialist
  • Murrieta, CA
  • NPI 1407845092
  Medicare reassignment
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Cassidy Medical Group Inc.

  • Multi-Specialty Clinic/Center
  • Vista, CA
  • NPI 1215003470
  NPD
• Centers for Family Medicine GP

  • Family Medicine Physician
  • Los Alamitos, CA
  • NPI 1467598243
  NPD
• Cep America - California

  • Emergency Medicine Physician
  • Moreno Valley, CA
  • NPI 1215042338
  NPD
• New Day Institute

  • Marriage & Family Therapist
  • Riverside, CA
  • NPI 1043691025
  NPD (past)

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1235510504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5957 W RAMSEY ST",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203058",
            "telephone_number": "951-845-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YERGENSON",
        "first_name": "RANDY",
        "middle_name": "STEVEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-12",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA-C",
            "identifier": "52594",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ting Wu, M.D.
• Vanessa Wyche, LCSW
• Tommy Yanez
• Jeffrey Xachao Yang, PHARMD
• Amy Yasul
• Glenda M. Yetter, N.P.
• Jeung Cjoo Yoo, MD
• Ju Hee Yoon, PHARM. D.
• Michael Kay Yoon, M.D.
• Carl Dennis Zingler, D.D.S.

• Physician Assistant in Banning, CA
• Providers in Banning, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.