NPIMap

Organization Active NPI

Innovi Healthcare Inc.

Doing business as Innovi Medical Group

  • Family Medicine Physician
  • Tustin, CA
National Provider Identifier
1275153389
Registry record updated Apr 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVI HEALTHCARE INC.
Doing business as
Innovi Medical Group
Practice address
11220 Amberdale Dr
Tustin, CA 92782-4329
Phone
(949) 336-1875
Fax
(844) 946-0854
NPI assigned
Apr 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2020

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

Authorized official

Name
Dr. Mariam S Hasan, MDNPI 1851604847
Title
Ceo
Phone
(949) 336-1875

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 PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11220 Amberdale Dr
Tustin, CA 92782-4329

Mailing address

11220 Amberdale Dr
Tustin, CA 92782-4329
Phone (949) 336-1875

Other names 1

  • INNOVI MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Innovi Healthcare Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587168000000",
    "number": "1275153389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11220 AMBERDALE DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927824329",
            "telephone_number": "949-336-1875",
            "fax_number": "844-946-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 AMBERDALE DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927824329",
            "telephone_number": "949-336-1875",
            "fax_number": "844-946-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVI HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-18",
        "last_updated": "2020-04-18",
        "certification_date": "2020-04-18",
        "status": "A",
        "authorized_official_last_name": "HASAN",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-336-1875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INNOVI MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.