Southern California Permanente Medical Group
Organization Active NPI Health Maintenance Organization · Riverside, CA
NPI 1316979834 · NPPES record last updated Nov 2, 2021
Key facts
- NPI
- 1316979834
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- Legal business name
- SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
- Practice address
- 10800 Magnolia Ave
Riverside, CA 92505-3043 - Phone
- (866) 984-7483
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ramin Davidoff, MD
- Title
- Executive Medical Director
- Phone
- (877) 608-0044
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 3
Practitioners 13,252
-
Mekabiz Abaian, MD
-
Danish Abbas, M.D.
-
Nisrin Abdelsamie, FNP
-
Behnam Abdollahi, MD
-
Solomon O. Abila, MD
-
Jenny Ahmed Abouelsood, M.D.
-
Hana Nazih Abuershaid, M.D.
-
Mauricio Acevedo, MD
-
Fernando Acosta, PA-C
-
Michael J. Adair, MD
-
Nichole Marie Adair, D.O.
-
Sheila Marie Adaya Adan, D.O.
-
Rosette Adegbe, FNP
-
Camille Adeimy, MD
-
Olufemi Michael Adenuga, M.D, MPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000823 | CA | Part B Supplier - Clinic/Group Practice | 6002729175 |
Receives reassigned benefits from 5,496 practitioners 7 other NPIs on this enrollment |
| O20260217001864 | CA | MDPP Supplier - in-Person MDPP Supplier With Distance Learning | 6002729175 |
12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
28150 Keller Rd
Murrieta, CA 92563
Phone (951) 251-6000
2295 S Vineyard Ave
Ontario, CA 91761
Phone (866) 454-3485
393 E Walnut St
#7097
Pasadena, CA 91188
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | Yes |
Addresses
Primary practice location
10800 Magnolia Ave
Riverside, CA 92505-3043
Mailing address
393 E Walnut St
3Rd FL PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0018332 | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) |
Other providers in Riverside, CA
- Southern California Emergency Medicine
- Southern California Emergency Medicine
- Southern California Occupational Medicine Providers, AMC
- Southern California Orthopaedic Specialists Medical Group
- Southern California Permanente Medical Group
- Southern California Transplantation Associates Inc
- Southern California Transplantation Institute
- Southern California Vein and Aesthetics LLC
- Southland Arthrites and Osteoporosis Medical Center Inc
- Southland Respiratory Inc
All providers in Riverside, CA · Health Maintenance Organization in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.