NPIMap

Organization Active NPI

Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
National Provider Identifier
1336977990
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INLAND PSYCHIATRIC MEDICAL GROUP, INC.
Practice address
1809 W Redlands Blvd
Redlands, CA 92373-8054
Phone
(909) 289-4075
NPI assigned
Jul 24, 2024
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Amber Gutierrez
Title
Provider Relations Manager
Phone
(909) 289-4075

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Social Worker 104100000X
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X

Addresses

Primary practice location

1809 W Redlands Blvd
Redlands, CA 92373-8054

Mailing address

1809 W Redlands Blvd
Redlands, CA 92373-8054
Phone (909) 289-4075

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000736 CA Part B Supplier - Clinic/Group Practice 9436062312 Receives reassigned benefits from 192 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moreno Valley, CA; Palm Desert, CA; Rancho Cucamonga, CA; Hemet, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; San Juan Capistrano, CA…

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Inland Psychiatric Medical Group Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

18523 Corwin Rd
Ste H
Apple Valley, CA 92307
Phone (760) 242-3000

540 W Baseline Rd
Ste 3
Claremont, CA 91711
Phone (909) 542-0633

12442 Limonite Ave
Unit 104
Eastvale, CA 91752
Phone (951) 344-4451

24012 Calle de la Plata
Ste 450
Laguna Hills, CA 92653
Phone (949) 768-6845

23110 Atlantic Cir
Ste E
Moreno Valley, CA 92553
Phone (951) 243-6455

73345 Highway 111
Ste 203
Palm Desert, CA 92260
Phone (760) 340-3158

30240 Rancho Viejo Rd
Ste E
San Juan Capistrano, CA 92675
Phone (949) 226-6914

2372 Sterling Ave
Sn Bernrdno, CA 92404
Phone (909) 422-8029

14350 Civic Dr
Ste 280
Victorville, CA 92392
Phone (760) 243-7700

36243 Inland Valley Dr
Ste 220
Wildomar, CA 92595
Phone (909) 696-5220

56970 Yucca Trl
Ste 104
Yucca Valley, CA 92284
Phone (760) 365-3711

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 181

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 181

NPI Registry JSON

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

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1336977990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054",
            "telephone_number": "909-289-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054",
            "telephone_number": "909-289-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND PSYCHIATRIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "PROVIDER RELATIONS  MANAGER",
        "authorized_official_telephone_number": "909-289-4075"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.