NPIMap

Organization Active NPI

Internal Medicine Medical Group

  • Internal Medicine Physician
  • Pomona, CA
National Provider Identifier
1316140619
Registry record updated Oct 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE MEDICAL GROUP
Practice address
1866 N Orange Grove Ave
Suite 102
Pomona, CA 91767-3031
Phone
(909) 865-0676
Fax
(909) 865-8483
NPI assigned
Jun 6, 2007
Last updated
Oct 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2007

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

Authorized official

Name
Mrs. Adrienne Marie Walker
Title
Contracts Manager
Phone
(909) 398-1550

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X
Pulmonary Disease Physician 207RP1001X

Addresses

Primary practice location

1866 N Orange Grove Ave
Suite 102
Pomona, CA 91767-3031

Mailing address

840 Towne Center Drive
Pomona, CA 91767-3031
Phone (909) 398-1550

Other identifiers 1

IdentifierTypeStateIssuer
GR0011290MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine Medical Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1316140619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DRIVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673031",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 N ORANGE GROVE AVE",
            "address_2": "SUITE 102",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673031",
            "telephone_number": "909-865-0676",
            "fax_number": "909-865-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CONTRACTS MANAGER",
        "authorized_official_telephone_number": "909-398-1550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0011290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.