NPIMap

Organization Active NPI

Regenerative Medical Group Inc

  • Family Medicine Physician
  • Idyllwild, CA
National Provider Identifier
1366051419
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REGENERATIVE MEDICAL GROUP INC
Practice address
54910, Pine Crest Avenue
Idyllwild, CA 92549
Phone
(951) 659-9912
NPI assigned
Jul 24, 2020
Organization subpart
Yes
Parent organization
REGENERATIVE MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Authorized official

Name
Bryn Jarald HendersonNPI 1447296694
Title
Owner
Phone
(714) 639-4012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

54910, Pine Crest Avenue
Idyllwild, CA 92549

Mailing address

54910, Pine Crest Avenue
Idyllwild, CA 92549

National Provider Directory

National Provider Directory
Tax ID family
Regenerative Medical Group7 organizations share this tax ID, including this one
Part of
Regenerative Medical Group

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1366051419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54910, PINE CREST AVENUE",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "92549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54910, PINE CREST AVENUE",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "92549",
            "telephone_number": "951-659-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENERATIVE MEDICAL GROUP INC",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "BRYN",
        "authorized_official_middle_name": "JARALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-639-4012"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idyllwild, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.