NPIMap

Organization Active NPI

Shiloh Medical Center Inc

  • Family Medicine Physician
  • Victorville, CA
National Provider Identifier
1245333830
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHILOH MEDICAL CENTER INC
Practice address
12332 Hesperia Rd
Ste a
Victorville, CA 92395
Phone
(760) 243-4009
Fax
(760) 243-3255
NPI assigned
Sep 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Charmaine E Earle, MDNPI 1598833303
Title
President
Phone
(760) 243-4009

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

12332 Hesperia Rd
Ste a
Victorville, CA 92395

Mailing address

12332 Hesperia Rd
Ste a
Victorville, CA 92395
Phone (760) 243-4009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050926001173 CA Part B Supplier - Clinic/Group Practice 2163456377 Receives reassigned benefits from 6 practitioners
Practice locations: Victorville, CA

National Provider Directory

National Provider Directory

Locations

12332 Hesperia Rd
Ste A
Victorville, CA 92395
Phone (760) 243-4009

12984 Hesperia Rd
Ste 101
Victorville, CA 92395
Phone (760) 243-4009

Practitioners & affiliated clinicians

Practitioners 11

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": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245333830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12332 HESPERIA RD",
            "address_2": "STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-243-4009",
            "fax_number": "760-243-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12332 HESPERIA RD",
            "address_2": "STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-243-4009",
            "fax_number": "760-243-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHILOH MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EARLE",
        "authorized_official_first_name": "CHARMAINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-243-4009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.