NPIMap

Organization Active NPI

Montclair Emergency Medical Associates

  • Emergency Medicine Physician
  • Montclair, CA
National Provider Identifier
1316044696
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MONTCLAIR EMERGENCY MEDICAL ASSOCIATES
Practice address
5000 San Bernardino St
Montclair, CA 91763-2326
Phone
(909) 625-8307
Fax
(909) 625-8255
NPI assigned
Sep 20, 2006
Last updated
Nov 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Miss Justine Guevara
Title
Department Coordinator
Phone
(424) 241-1546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

5000 San Bernardino St
Montclair, CA 91763-2326

Mailing address

PO Box 80456
City of Industry, CA 91716-8402
Phone (310) 379-2134

Other identifiers 1

IdentifierTypeStateIssuer
GR0104390MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070123000593 CA Part B Supplier - Clinic/Group Practice 8022019702 Receives reassigned benefits from 110 practitioners
Practice locations: Montclair, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 127

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.

View all 127

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1316044696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80456",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168402",
            "telephone_number": "310-379-2134",
            "fax_number": "310-379-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SAN BERNARDINO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632326",
            "telephone_number": "909-625-8307",
            "fax_number": "909-625-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR EMERGENCY MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "GUEVARA",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_title_or_position": "DEPARTMENT COORDINATOR",
        "authorized_official_telephone_number": "424-241-1546",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0104390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.