NPIMap

Organization Active NPI

Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
National Provider Identifier
1316979834
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 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
Last updated
Nov 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Dr. Ramin Davidoff, MD
Title
Executive Medical Director
Phone
(877) 608-0044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

Locations

2055 Kellogg Ave
Corona, CA 92879
Phone (951) 898-7010

393 E Walnut St
#7097
Pasadena, CA 91188

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

5225 Canyon Crest Dr
Riverside, CA 92507
Phone (951) 244-4147

Practitioners & affiliated clinicians

Practitioners 5,611

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 5,611

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1316979834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "address_2": "3RD FL PHR GROUP & PROVIDER ENROLLMENT",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "626-405-7914",
            "fax_number": "626-405-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "866-984-7483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "DAVIDOFF",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-608-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.